In April 1995, the Co-Chairs of the Judiciary Committee of the
Connecticut General Assembly asked the Connecticut Law Revision Commission to conduct a
study of Connecticuts drug policy (See Appendix A). The Commission was asked to
conduct a study "broad enough to present a substantive report on the ramifications of
our current drug policy and of alternative models" and to make "recommendations
for appropriate modification of the laws." Specifically, the Commission was asked to
study at least the following five areas:

1. The effectiveness of current criminal penalties for the illegal sale
and possession of controlled substances;

2. The effect that alteration of criminal penalties for illegal sale
and possession would have on the incidence and treatment of substance abuse, the incidence
of other crime, the overcrowding of correctional facilities, and the availability of
resources within the law enforcement and criminal justice systems;

3. The effectiveness of current substance abuse treatment and education
programs;

4. The relationship between welfare and the illegal sale and possession
of drugs; and

5. The outcomes of drug control programs in other states and countries
including at least one study of the medicalization of the drug laws and the effect that
these programs have had on crime, welfare, and substance abuse.

In September, 1996, the staff of the Law Revision Commission issued a
report that reviewed Connecticuts current substance abuse polices and practices and
raised a number of questions about what our policy should be. This report is a
continuation of the September report and suggests a broad systematic approach to
addressing those issues.

Experts and non-experts agree that substance abuse is a major -- if not
the number one -- health problem in this country. Studies suggest that more deaths,
illnesses and disabilities occur as a result of substance abuse than any other preventable
health condition. Costs related to substance abuse are a major contributor to the
countrys total health care bill. Additionally, substance abuses total economic
cost to the U.S. economy -- including increased health care costs, poor health,
absenteeism and reduced productivity in the workplace, and drug related crime and violence
-- each year is astronomical. In 1994 Connecticut spent $2.96 billion on substance abuse
costs.

The state urgently needs more effective ways of dealing with the
problem of drug abuse. The cost of the current system, in both human and economic terms,
is enormous. No sound evidence exists that current policies have effectively limited or
controlled the problems resulting from drug abuse. Indeed, some current policies may be
counterproductive. With the spread of AIDS by injecting drug users, a new urgency exists
to bring all drug abusers within the health care system.

Several conclusions can be reasonably drawn.

As a means of "solving" the drug problem, it appears
that the states heavy reliance on the criminal justice system is misplaced. One
federal prosecutor in Connecticut observed that "it is clear that we cant
arrest our way out of the drug problem." Connecticuts Chief States
Attorney reported to the Criminal Justice Subcommittee of the Connecticut Alcohol and Drug
Policy Council that incarceration has not been the solution to the drug problem and that
new and innovative ideas must be attempted.

Although penalties and sanctions may be an important component of
addressing drug abuse, the fundamental reliance on the criminal justice system, with its
enormous costs, has failed to solve the problem. A recent survey of police chiefs points
out that a majority of them believe that there is an urgent need to rebalance current drug
policies based on criminal sanctions more toward prevention, education, and treatment.

Connecticut needs coordinated, considered steps toward a public
health emphasis to drug policy. Such a public health approach does not reject the
important role of law enforcement and criminal justice to provide for the public safety.
Within that public safety context, the criminal justice system should also be an intake
point for treatment, an opportunity to engage most nonviolent, low-risk drug-involved
offenders into treatment and intervention. Moreover, the states preferred goal
should be to prevent or successfully treat drug abuse before the state triggers reliance
on the criminal justice system.

The problem of drug abuse is multifaceted. It is not solely a
criminal, social, or health problem. As such, its solution requires a policy that is
equally broad, that addresses the problems stemming from drug abuse in each of its
component parts. Such a policy must be coordinated and must analyze potential solutions in
terms of effectiveness and reduction in social and economic costs. That policy should
recognize that, for many persons involved with drugs, prevention, treatment, and education
can be more effective, and more cost effective, than reliance on penal sanctions.

Treatment for substance abuse is central to reducing
self-destructive behavior, crime attendant to dependence, and public health and other
social risks. Numerous studies (some of which are listed in strategy option B, below)
demonstrate the effectiveness of treatment, compared with incarceration, in addressing
substance dependence and in reducing criminal behavior. The central objective of treatment
is abstinence of use of illicit drugs, but because of the chronic, complex nature of drug
problems, the more pragmatic day-to-day objective is to reduce illicit drug consumption by
as large a fraction as possible relative to the consumption one might expect in the
absence of treatment. Reduction of illicit drug consumption produces socially and
personally valuable results and may serve as a critical intermediate step to lifetime
abstinence.

The goals of treatment include:

Reduce illicit drug use.

Reduce attendant criminal behavior.

Improve social functioning including housing, education, and employment
or productivity.

Improve users overall health, psychological functioning, and
family life.

Reduce fetal exposure to drug use.

Drug dependence is a chronic, relapsing condition. Thus, like other
chronic conditions such as diabetes, hypertension, and congestive heart failure,
continuing interventions may well be necessary. In fact, drug treatment professionals say
that relapse is part of recovery. Generally, the longer a dependent person stays in
treatment, the more successful it is.

Connecticut has a chronic lack of treatment capacity and
availability. Unfortunately, the need is real, but the shortage of treatment availability
is difficult to quantify. For example, Judicial Department and Correction officials report
that hundreds of persons are imprisoned each year who could safely and more cheaply and
effectively be supervised in community residential treatment programs. Connecticut is,
however, at least 200 residential treatment slots short of the need for this criminal
justice population. See strategy option C. 4, below. The Commission expects that a state
office to collect and analyze criminal justice and substance abuse data will assist in
determining overall state need. See strategy option B, below. Most importantly, the
Commission supports the recommendation of the Governors Blue Ribbon Task Force on
Substance Abuse to have, within three years, a system that fully meets treatment and
prevention needs.

The Law Revision Commission recommends that the legislature
review further and consider the following as strategy options, which are addressed in
depth in the more specific sections that follow this summary.

o Connecticut needs an office to develop, coordinate, assess, and
monitor its criminal justice and public health strategies for minimizing substance abuse.

A state infrastructure is necessary to develop and coordinate such a
new approach to drug policy. Such a body is necessary to develop evidence as to the
effectiveness of programs, recommend allocations where they are most effective, modify
current policies and programs where necessary, and initiate, oversee, and evaluate new
programs as they are established.

The legislature should, therefore, review further and consider as
a strategy option establishment of a state office (1) to implement a central, statewide
coordination of drug policies and (2) to coordinate a graduated, and considered, policy
shift to better address the health and social components of the drug abuse problem and to
reduce the heavy burden imposed by current reliance on the criminal justice system. See
strategy option B, below.

o Connecticut should implement revisions in its public
health programs to shift substance abuse priorities toward assessment, intervention,
education, and treatment where those activities are effective and cost efficient.

The Commission points out a number of public health initiatives to
address the health components of the substance abuse problem, including programs to:

1. Increase access to methadone treatment services through a
pilot program to allow treatment by clinic affiliated private physicians, through a
program allowing methadone treatment for certain incarcerated persons, and through
increased flexibility in methadone access to treatment and in treatment at long-term care
facilities;

6. Exempt, as allowed by federal law, those persons convicted of
substance abuse from the federal disability for welfare benefits;

7. Monitor and assess, within the Department of Education,
current prevention, education, and intervention programs with respect to substance abuse
and their coordination with available community-based programs;

8. Expand access to clean syringes; and

9. Revise the definition of drug dependence.

Those strategy options and others are detailed in C. through
C.11, below.

o Connecticut should revise its criminal justice programs to reflect
the shift toward treatment while retaining components necessary for public safety and to
discourage substance abuse.

As noted above, the states current heavy reliance on the criminal
justice system to control drug abuse has been misplaced. Policies relying heavily on penal
sanctions and incarceration have proven to be costly both in economic and human terms and
have failed sufficiently to address the social and public health aspects of the problem.
Nonetheless, criminal laws administered in concert with treatment and other social and
public health initiatives will continue to play an important role in controlling drug
abuse.

Those policies must, however, be revised to optimize the social
benefits, and minimize the social and economic costs, that accompany criminal law
enforcement. An arrest of a drug involved offender must be recognized, within the context
of public safety, as an opportunity to direct the offender to needed treatment. The first
goal with respect to such an offender must be to return that person to society in a
constructive role, receiving necessary treatment and without the stigma of conviction and
incarceration. Of course, public safety concerns will not always allow such an approach.
Where the offender is violent or implicated in other crimes, sanctions such as
incarceration may often be appropriate. The first, and primary, approach, however, must be
to maximize the use of alternative programs. Diverting appropriate offenders to treatment
before trial can successfully reduce repeat criminal behavior and avoid the lifetime
disability in the employment market that a conviction can bring. With recalcitrant
offenders, post-conviction treatment programs and alternatives to incarceration must be
used wherever reasonable.

To implement such a shift in policy, the legislature should
review further and consider as strategy options the following specific changes in existing
laws and practice:

1. Expansion of the drug court. Current pilot programs
establishing drug courts in Connecticut and elsewhere are proving highly effective in
allowing the system to design the appropriate response, including treatment and other
options, for specific offenders. The legislature should, therefore, consider expansion of
drug courts statewide and include all offenses in which drug abuse is the primary factor.

2. Penalties for drug sales. The current penalties need review to
assure that they meet current criminal justice and substance abuse policy needs.

3. Expand use of alternative incarceration programs. Alternatives
to incarceration, including drug education programs and community service, should be
emphasized. Where a drug abuser is, in fact, incarcerated, that incarceration should be
used as an opportunity for treatment.

4. Drug education and community service labor program. Include drug
treatment/education components as part of the community service labor program.

5. Community policing. The legislature should encourage community
policing techniques and philosophy.

These strategy options and others with respect to the criminal
justice system are set out in strategy options D.1 through D.7, below.

As noted above, the specifics and rationales for each of the
specific programming, public health, and criminal justice strategy options follow.
However, it should be emphasized that this shift toward public health goals requires
ongoing review and revision to ensure that programs prove effective and that substance
abuse harms are minimized in a humane and cost efficient manner. The bulk of that
monitoring should fall on the state central office established to coordinate policies,
formulate strategies, and assess the effectiveness of programs and on the advisory council
established to provide agency and program feedback.

The Law Revision Commission staff review of
Connecticuts current drug policy, as well as the November 1996 draft recommendations
of the Connecticut Alcohol and Drug Policy Council and the December 1996 recommendations
of the Connecticut Legislative Program Review and Investigations Committee, notes
deficiencies in Connecticuts piecemeal approach to substance abuse problems. That
approach, which historically developed as the state reacted to limited aspects of the
substance abuse problem, has relied heavily on penalties and sanctions imposed by the
states criminal justice system, and, to a lesser extent, on substance abuse
treatment that is available, or imposed, only inconsistently. Connecticut policy has also
made only limited and uncoordinated use of prevention and education strategies. This
haphazard approach has incurred enormous costs often with only limited successes, has
failed to make an optimal use of treatment and other effective strategies, and has led to
inconsistencies in policy and inappropriate competition for resources among state
agencies.

To resolve these deficiencies in current substance abuse
policies, the legislature should consider centering in one state office the authority to
develop, coordinate, and direct a comprehensive statewide substance abuse policy that
applies to all the players in the substance abuse field.

Coordination responsibilities could be placed in the Office of
Policy and Management (OPM) as a division of substance abuse policy and management for the
same reasons that OPM, itself, exists: because it is imperative that one body coordinate
implementation of state policy, and allocation of state resources, in this critical area.
The Office of Policy and Management already exists to coordinate state policies across all
state agencies, including the Judicial Department. A specific division within that office
could be expressly dedicated to the substance abuse problem to bring all of the currently
disparate state policies on substance abuse within a single umbrella. OPM may be best
positioned to coordinate practices and resources not only for substance abuse treatment
and prevention, but also for the judicial and criminal justice systems.

Another option places coordination responsibilities in the
Department of Mental Health and Addiction Services (DMHAS) or the Department could be
designated as the lead agency for the coordination role. DMHAS has lead state
responsibility for delivery of treatment and prevention services, and therefore has
expertise and experience in the coordination and delivery of services. However, OPM, as a
superagency already charged with oversight and budgeting responsibility, is more
strategically positioned than is DMHAS to coordinate programing and policy and
standardized data collection and evaluation among various state agencies that are coequal
with DMHAS and to address criminal justice issues in the Judicial Department.

A Substance Abuse Policy Council should assist the drug policy
coordinating office (see B. 4, below). It is expected that the present Connecticut Alcohol
and Drug Policy Council created by executive orders in August 1996 would, by statute,
become the advisory policy council to the coordinating office. This would assure constancy
and statutory status to the Policy Council. It is expected that the Policy Council would
continue, with most of the same participants, the work of the replaced Connecticut Alcohol
and Drug Policy Council.

The new coordinating office should develop and implement the
substance abuse policy statewide. The policy should focus on substance use and abuse as a
public health issue and should address it in a comprehensive and coordinated manner. The
policy should rely on the best techniques of prevention, intervention, treatment,
education, and criminal justice. The goal of the drug policy should be to minimize,
overall, the disparate social and economic costs related to drugs: the costs to society of
drug use, of production and distribution, and of control efforts. It is easier, but not as
useful, to focus on each of these parts of the drug problem separately. For example, the
government could perhaps reduce drug use by dramatically increasing criminal enforcement
and sanctions, or it could decrease costs of a black market distribution system by
government dispensing drugs to certified addicts at rates below the black market, or the
government could decrease drug control costs by eliminating government programs concerning
drugs. Attempting to focus on each cost independently, while easier, is not as useful as
the more difficult task of minimizing the aggregate cost of use, production and
distribution, and control.

Barry McCaffrey, director of the White Houses Office of
National Drug Control Policy, points out that prevention and treatment of substance abuse
is more effective and cheaper than interdiction and incarceration. General
McCaffreys position is supported by numerous studies and reports that encourage a
public health approach to drug policy and that demonstrate the effectiveness of treatment
on drug use and crime when compared with incarceration. Connecticut needs coordinated,
considered steps toward a public health emphasis to drug policy. Such a public health
approach does not reject the important role of law enforcement and criminal justice to
provide for the public safety. Within that public safety context, the criminal justice
system should also be an intake point for treatment, an opportunity to engage most
nonviolent, low-risk drug-involved offenders into treatment and intervention. Moreover,
the states preferred goal should be to prevent or successfully treat drug abuse
before the state triggers reliance on the criminal justice system.

The policies of the State Department of Education, Department of
Children and Families, Department of Mental Health and Addiction Services, and other
agencies should be coordinated to ensure that children and young adults receive the most
effective education and intervention to minimize the risks of substance abuse. The more
specific recommendations made with respect to the State Department of Education (see
strategy option C.7. below) should be integrated into the state comprehensive plan for
dealing with substance abuse.

The new drug policy office should develop a data base to
allow monitoring of the effectiveness of programs. Establishing such a data base will
require standardized policies and procedures for collecting and evaluating information.
Too often under current policy, each agency collects only the information necessary for
its own administrative considerations. Moreover, the data format is often incompatible
with data from other agencies with substance abuse responsibilities.

Absence of a current, standardized, centralized data base has
made it impossible to evaluate the relative effectiveness of many current programs and of
criminal sanctions. For example, Judicial Department information on court dispositions of
drug offense cases does not reveal the type of drug involved, i.e., heroin or cocaine;
marijuana or a misused prescription drug. Thus, it is difficult for administrators to
determine with accuracy the kinds of drugs for which persons are being convicted and
trends in arrest by drug type. Court case disposition data classifies race by white,
Hispanic, black, Asian, or other. Police arrest data in the Uniform Crime Reports,
however, does not contain the category of Hispanic; Hispanics are recorded as white. This
procedure makes it difficult to determine, for example, whether conviction rates for each
population group are consistent with the arrest rates. An effective, statewide system must
use scientifically-valid measures to evaluate programs and sanctions, both those that are
currently implemented and new ones that are developed. Such a system will, of course, need
to be developed within the context of federal and state confidentiality laws.

Finally, the Commission believes that a statutory Substance
Abuse Policy Council (to replace and continue the work of the Connecticut Alcohol and Drug
Policy Council, see B. 4, above) would be an indispensable part of the work of the drug
policy office. The Policy Council should consist of representatives of the leading
agencies and others expert in substance abuse policy to assist the new office in the
formulation of its statewide policy. The council will ensure that the new policy office
has direct access to all available state expertise and that the policy office receives
agency and other expert opinion with respect to current and proposed policies.

Should the legislature choose to create a drug policy office in
OPM, a draft of legislation that would accomplish that result is in Appendix B, Bill No.
1, page B-1. The legislation is consistent with the draft recommendations of the
Connecticut Alcohol and Drug Coordinating Council and parallels recommendations of the
Legislative Program Review and Investigations Committee.

Over two million Americans have tried heroin, the most commonly
abused opiate drug in the United States. Statistics suggest that there are over 500,000
heroin dependent persons nationwide, and a comparable number using it regularly. In
Connecticut, the Governors Blue Ribbon Task Force on Substance Abuse estimated that
65,000 Connecticut residents abused illegal drugs in 1995 - about 1.9% of the total
Connecticut population. Heroin abuse accounts for almost half (49%) of the persons treated
for illicit drug use by the State of Connecticut Department of Mental Health and Addiction
Services for the fiscal year 1995.

Nationally, heroin use grew rapidly in the 1960s, leveled off in
the 1970s and 1980s, and appears to be increasing again. Hospital emergency rooms
experienced an 80% increase in heroin related treatments between 1990 and 1993. The
average purity of heroin has increased from 5% in the 1980s to 40-60% today.

Chronic heavy users often suffer from poverty and thus are more
susceptible to diseases associated with poverty. Abusers are often inattentive to their
personal hygiene and may experience extreme deterioration of their health. Because heroin
is often administered by shared needles, there is an increased risk of exposure to
hepatitis, and Human Immunodeficiency Virus (HIV), which can lead to Acquired Immune
Deficiency Syndrome (AIDS). Not surprisingly, heroin-dependent persons often exhaust
financial resources to support the dependence and turn to criminal activity as a means of
support.

No method of treatment for heroin dependence is as successful as
long-term high dose methadone maintenance treatment (MMT). Methadone successfully
addresses the severity of dependence, safeguards the public health by reducing
transmission of the HIV virus, and enhances public safety and reduces criminal behavior of
patients - so effectively that it has been called the "anticrime pill."

In one study, new HIV infection rates among persons in methadone
treatment were six times lower than new HIV infection rates among those injection drug
users not in methadone treatment.

Methadone hydrochloride is a pharmaceutical medication, a
synthetic opiate product, similar to heroin in that it causes dependence, but without the
ability to produce the "high" in opiate-dependent persons. Persons treated with
methadone can safely drive and operate machinery. They can hold jobs and maintain a normal
family and social life. When properly prescribed and administered, methadone provides
relief from acute withdrawal symptoms and reduces chronic narcotic craving by stabilizing
blood levels of the drug as it metabolizes, letting the heroin dependent person function
normally without being "high". Methadone has the additional advantage of being
metabolized over 24 to 26 hours, about six times longer than heroin, and it can be taken
orally. Importantly, methadone is safe for both short-term and long-term use. Methadone
maintenance treatment allows the individual to live with an opiate dependency by
minimizing its effects on his or her psychological and social well-being.

An estimated 115,000 individuals receive methadone treatment
nationally; 4,358 did in Connecticut during 1995. A "snapshot" shows that 3,231
persons were in methadone treatment in Connecticut in September 1996, up from 2,462 in
June 1996, a 31 % increase in only three months. The Connecticut Department of Mental
Health and Addiction Services estimates that of the 15,000 people currently in heroin drug
treatment programs, only 20% are receiving methadone treatment.

Despite the overwhelming evidence supporting methadone
maintenance treatments positive impact on crime and public safety, public health,
and social outcomes, the United States and Connecticut have fallen behind the successful
use of methadone in other western nations. While the number of methadone maintenance
treatment placements rose to 100,000 between 1965 and 1980, there has been little increase
in methadone maintenance treatment availability since the advent of the AIDS epidemic
fifteen years ago. By contrast, Australia increased its methadone maintenance treatment
placements ten-fold in recent years, as did Germany.

Private practitioners do not commonly prescribe and dispense methadone
in the United States. Federal and state regulations discourage the practice for fear of
inappropriate use of the medication and a claimed higher risk of diverting the medication.
In fact, however, the Institute of Medicine found that these fears were overstated.
Diverted methadone medication is generally used by out-of-treatment heroin-dependent
persons to self-moderate their own heroin use or to substitute for heroin when it is in
short supply. Although methadone is a powerful medication like many other prescription
drugs, the Institute of Medicine found that diverted methadone is but a small part of the
drug abuse problem, and that it does not play a significant role in drug-related deaths or
emergency health care.

Because the strict regime of controlling methadone medication
unnecessarily prevents many heroin-dependent persons from receiving methadone maintenance
treatment, the Institute of Medicine has recommended that the restrictions be modified.
Outreach activity by treatment programs and by community-based health programs such as
needle exchange is an important method of engaging more opiate-dependent persons into
treatment. Failure to promote and use methadone maintenance treatment for heroin
dependence results in otherwise preventable crime, increased transmission of disease such
as AIDS, and impaired psychological and social functioning.

Outside the United States, methadone delivery has been expanded
by integrating it into general medical practice. In Europe, Australia, and Canada
thousands of general practitioners are involved in methadone maintenance. This scenario
allows access to users who live far from or cannot get to clinics, is less stigmatizing,
and grants a greater role to the medical community in methadone maintenance. In the
Netherlands, the United Kingdom, Canada, and Australia, syringe exchange programs (SEPs)
are integrated with methadone programs.

The Law Revision Commission has explored ways to make more
methadone maintenance treatment available outside traditional programs, as well as ways to
make methadone maintenance treatment more available through traditional programs. The
Commission formed a Methadone Working Group to study the issue and to make
recommendations. The Working Group was made up of representatives of the Department of
Mental Health and Addiction Services, the Department of Public Health, the Department of
Correction, methadone program and other treatment providers, physicians in private
practice, physicians and researchers in the Yale University Department of Biology and
School of Medicine, including the Departments of Internal Medicine and of Epidemiology and
Public Health, the New Haven Police Department, and a methadone patient. The group was
advised by methadone treatment providers at a New York City jail and by an official from
the state of New York State office that regulates methadone treatment.

Although the number of persons receiving methadone treatment
during three months of 1996 increased by 31%, the Methadone Working Group found that
treatment need still far exceeds treatment availability. Without new initiatives, such as
those reported here, the Working Group did not expect that program use would continue to
expand. For example waiting lists for treatment more than doubled during that same time
and some clinics report delays of up to two months for receiving treatment.

Based on the efforts of the Working Group, the Law Revision
Commission reports on the following methods to increase access to methadone treatment in
Connecticut:

a. A pilot research program of methadone treatment by private
physicians for stabilized methadone patients. The physicians would be affiliated with, but
off site from, methadone clinics.

b. A methadone medication as a detoxification treatment (21 days) for
opiate-dependent persons who become incarcerated.

c. A pilot research program of methadone maintenance treatment for
inmates who are both incarcerated for a short-term and opiate-dependent to prepare
linkage to community-based methadone treatment on their release.

d. The Department of Mental Health and Addiction Services should
continue to improve its system of monitoring quality of care of methadone maintenance
treatment programs to assure access to treatment that meets patient needs and to eliminate
any waiting time for access to treatment. The Department should report its progress in
these issues to the legislature.

e. The Department of Public Health and Department of Mental Health and
Addiction Services should develop systems that permit physicians at long-term care
facilities to modify methadone prescriptions for patients on methadone maintenance
treatment.

The reported methods to increase access to methadone are explained in
more detail below.

The legislature could create a statewide pilot research program in
which physicians would treat stabilized methadone patients in a private practice or other
medical setting rather than at methadone clinics. Methadone clinics would continue to
serve as the intake point for treatment. After the patients condition is stabilized
at the clinic, the patient would transfer to a private practice physician affiliated with
the clinic. Should the patient in the care of a private physician again need the services
of the clinic, care would be transferred back to the clinic. Such a coordinated treatment
scheme is used successfully in the Netherlands and other nations. Importantly, in October
1996, the American Methadone Treatment Association, Inc. endorsed moving to such a system
of private, physician-based treatment.

The pilot program would be established by the Department of Mental
Health and Addiction Services which will establish an advisory committee of methadone
experts to develop protocols and to provide ongoing review of the pilot program.

The program will:

Allow methadone patients to be treated in a private practice setting
which, for many patients, will be more convenient and less burdensome than treatment in a
clinic. The result should be better patient compliance with treatment and improved
retention rates of patients in treatment. The most important indicator for successful
treatment is maintaining a patient in treatment.

Provide more clinical space for new patients.

Establish a group of private practice physicians who become experienced
in methadone maintenance treatment.

Inform the methadone treatment system about ways to decentralize the
clinical dispensing of the medication. A decentralized dispensing system will help reduce
neighborhood complaints about concentrations of opiate-dependent patients at clinic
locations, it will be less expensive to operate, and it will increase patient use of
methadone by treating patients in physician offices, just as persons with other chronic
disorders are treated.

Conduct a rigorous evaluation of its effectiveness, and possibly a
randomized clinical trial.

Require that clinics affiliate with at least two physicians in the
first year, to ease startup training and supervision burdens. Thereafter, at least five
physicians must be affiliated with the program. It is expected that programs will, in
fact, be able to affiliate with more than the minimum number of physicians called for.

b. Methadone medication as a detoxification treatment (21 days) for
opiate-dependent persons who become incarcerated.

Because of strict limitations on the availability of opiates during
incarceration, opiate-dependent inmates suffer withdrawal from opiates. Withdrawal causes
extreme physical distress and is characterized by abdominal pains, chills, nausea,
diarrhea, and fever. Methadone detoxification treatment (21 days) is the standard medical
procedure for treating such opiate withdrawal symptoms. It relieves the extreme physical
distress of withdrawal and reduces prisoner disruptive behavior.

Methadone detoxification treatment is currently available in the
Connecticut correction system to detoxify female prisoners who have been maintained on
methadone maintenance while pregnant in prison. Methadone detoxification is not available
for male prisoners or other female prisoners. Methadone detoxification is also used in
prison systems in other states. The Methadone Working Group recommended to the Law
Revision Commission that the legislature assure that this medical procedure be available
to treat the large number of opiate-dependent persons entering the state prison system.

Testing for opiates costs about $1.50 per person. If outside
contractors provide opiate detoxification with methadone, the service costs about $65 per
week per person.

No reliable data is available about the number of persons
entering the Connecticut correction system annually who show indication of opiate use.
Members of the Methadone Working Group estimated that up to 40% of the 100,000 admissions
to Corrections each year may show opiate use on admission.

At the Law Revision Commissions Methadone Working Group,
representatives of the Department of Correction indicated that, while the Department
believes that its current detoxification program is adequate, the Department would
consider using methadone detoxification treatment where advisable.

c. A pilot research program of methadone maintenance treatment for
inmates who are both incarcerated for a short-term and are opiate-dependent to prepare for
their release from incarceration to a community-based methadone treatment program.

Upwards of 40,000 newly-admitted inmates to the Connecticut
correctional system each year show signs of opiate use. The Methadone Working Group
estimated that hundreds, if not thousands, of them are pretrial detainees or have received
short sentences and will be released into Connecticut communities within a year of
incarceration. These released inmates will not have been engaged in prison in the most
successful opiate treatment program known - methadone maintenance treatment.

The Methadone Working Group recommended to the Law Revision
Commission that the legislature create a pilot research program of short-term methadone
treatment and support services to appropriate inmates who are at risk of resuming opiate
use upon release.

This proposal engages opiate-dependent inmates who are to be
incarcerated for a short time into a short-term methadone maintenance treatment in prison
and transfers them to community-based methadone maintenance treatment on release. The
program is designed to break the cycle of: opiate use, criminal behavior and high risk
health behavior caused by the opiate use, arrest, incarceration-imposed termination from
opiates, release and return to opiate use, criminal and high risk health behavior,
rearrest, reincarceration.

A pilot research program of methadone maintenance would be
created at two locations: (1) at York Correctional Institution, Niantic, which serves
women, and (2) at an intake facility for men in one of Connecticuts cities.

The proposal is based on a successful program, called KEEP,
operated at a New York City jail (Rikers Island) since 1988. The program serves as an
intake facility for methadone maintenance treatment for opiate-dependent inmates who are
to be incarcerated for only a short period - less than one year. The dependent inmate is
maintained on methadone while incarcerated. Upon release, the inmate is referred to a
community-based methadone maintenance treatment program, where a treatment slot has been
reserved. The program serves over 400 inmates daily and 3800 during the year. It measures
its success by the number of participants who, in fact, enroll in the community program on
release - now approaching 80%.

The KEEP program was established with federal and state support
despite prison opposition from administrators and guards. Concerns centered around the
treatment modality and the feasibility of providing methadone in a prison setting. Issues
such as possible diversion of medication, violence, and security breaches needed to be
addressed. Connecticut Department of Correction representatives in the Methadone Working
Group indicated that the Department has similar concerns. Shortly after the program was
established in the New York City jail, however, the programs value became apparent
and it received institutional support from both administrators and guards. Prisoners who
entered the program accepted the medication and their behavior improved. Their opiate
abstinence syndrome (craving, anxiety, and depression) was also reduced. Since then, the
program has been expanded.

A similar program of short-term methadone maintenance had been
successfully used in the Hartford Morgan Street jail for about seven years in the 1970s.
The program maintained dependent persons on methadone for about forty-five days before
their release to a community-based methadone treatment program. A change in medical
philosophy at the jail ended the program.

Both the New York City jail program and the experience of the
Connecticut Department of Correction in providing methadone maintenance treatment to
pregnant opiate-dependent inmates in Connecticut have proven to be successful.
Representatives of the Department of Correction continue to express reservations, however,
about implementation of the proposed pilot program in Connecticut.

The pilot program is designed as an intake program for methadone
maintenance treatment for opiate-dependent inmates who are likely to be released into the
community in a relatively short period of time. Additionally, methadone maintenance
treatment will also address the abstinence syndrome (depression, anxiety, and craving)
that opiate-dependent inmates experience when kept abstinent from opiates.

Specifically, the program would serve every appropriate
opiate-dependent inmate serving a sentence of less than one year and incarcerated on or
after January 1, 1998, and all appropriate opiate-dependent pre-trial detainees held on
misdemeanors on or after January 1, 1998. Under subsections (a) and (b) the commissioner
may expand the program to other inmates, such as those charged with a felony who are
likely to be sentenced to less than a year and those with felony charges who are likely to
have their charges reduced to a misdemeanor. Because methadone treatment is both an
anticrime initiative and a public health measure, the treatment should be as widely
available as possible to every appropriate opiate-dependent inmate who is likely to be
incarcerated for a short period of time.

The Commissioner of Correction, with the aid of the Department of
Mental Health and Addiction Services (DMHAS) and representatives of community-based
methadone programs, would establish a program for the retention and transfer of treatment
of those individuals to community-based programs upon their release from incarceration.

If established methadone programs are contracted to operate the
inmate program, program costs are estimated at $2500 to $3000 per year for each program
slot. About $30,000 would be needed to evaluate the program. DMHAS will participate in
developing standard and protocols, and at that time it can be decided whether DMHAS or
some other organization should evaluate the program. The evaluation component of the
program could include an evaluation of its cost effectiveness. The evaluation will also
determine reincarceration rates after release - an evaluation component not done in the
New York program.

A registry is established to enable the state to identify a
program participant and to prevent participation in more than one community-based
treatment program. Connecticut presently has no such methadone registry.

d. The Department of Mental Health and Addiction Services should
continue to improve its system of monitoring quality of care of methadone maintenance
treatment programs to assure access to treatment that meets patient needs and to eliminate
any waiting time for access to treatment. The Department should report its progress on
these issues to the legislature.

One barrier to access to methadone maintenance treatment is program
rules and program staff attitudes that discourage patients from seeking treatment or that
make treatment inconvenient for patients. The Department of Mental Health and Addiction
Services indicates that, in the past year, it has been conducting its quality assurance
program with more frequency, care, and deliberation than in previous years. The Law
Revision Commission commends that effort and urges the Department to continue to improve
its quality assurance systems.

Immediate access to methadone treatment is an important element
of assuring that opiate-dependent persons are engaged in treatment when ready. Delay in
treatment to an opiate-dependent person means the person will continue behaviors that are
illegal and a grave risk to public health. And when treatment becomes available after a
delay, the person may no longer be interested in the program.

The Department indicates that prospective methadone patients
should, after assessment for appropriateness, be placed in treatment immediately, or
placed on a waiting list. The Department says that it has done a great deal to eliminate
waiting lists in the past several years. Yet, in the three months in 1996 when treatment
slots increased by 32%, waiting lists more than doubled - from 29 to 67. Furthermore,
anecdotal information from the courts, public defenders, treatment counselors, and social
workers indicates continuing delays in getting into methadone treatment. For example, an
informal survey on December 20, 1996, by some members of the Methadone Working Group of
three state-funded methadone treatment programs found a two-week delay in admission at one
program and a one to two month-delay at two other programs. Such unacceptable delays
unnecessarily threaten both public safety and public health.

The Law Revision Commission recommends that the Department continue
to review and to improve how programs are complying with waiting list standards and to
remove barriers to immediate access to treatment.

The Commission recommends that the Department report to the
Judiciary and Public Health Committees of the General Assembly in 1998 its progress in
improving quality assurance monitoring and in eliminating waiting times.

e. The Department of Public Health and Department of Mental Health and
Addiction Services should develop systems that permit physicians at long-term care
facilities to modify methadone prescriptions for patients on methadone maintenance
treatment.

As patients in methadone maintenance treatment age or become disabled
because of AIDS, more enter long-term care facilities. Physicians at these health
facilities are not permitted to modify a patients methadone medication as needed
because the patients are under the methadone maintenance care of clinics removed from the
health care facilities. The Law Revision Commission recommends that the Departments of
Mental Health and Addiction Services and of Public Health develop a system that allows
such physicians to modify methadone prescriptions for patients in their care.

Should the legislature choose to increase access to methadone, a
bill to enact proposals a, b, and c is located in Appendix B, Bill No. 2, page B-2. No
legislation is necessary to implement proposals d and e.

There is virtual unanimity that substance abuse should be treated
as a public health problem. Currently, Connecticut has mandated substance abuse insurance
benefits under group health policies, but that coverage is limited to confinement for
substance abuse treatment in a hospital or other recognized facility. As a result,
Connecticuts citizens presently have different limits and coverages -- on lengths of
stay and levels of care, treatment modalities, maximum annual or lifetime benefits,
deductibles and co-payments, and percentages reimbursed, for example -- for substance
abuse services and medical/surgical services, if they have substance abuse coverage at
all.

To curb the impact of substance abuse and to reduce significantly
the myriad costs associated with it, substance abusers must have early and ready access to
appropriate medical services. They must not be deterred from seeking such help by the
prospect of financial distress, and their health care providers must be encouraged to
provide such help secure in the knowledge that they will be appropriately compensated for
their health services. Equal treatment for substance abuse services is the way to achieve
the goal of early universal access to appropriate substance abuse health care services.
This view has been embraced by a number of experts who have studied the question of parity
of health insurance coverage for substance abuse treatment.

The issue of parity is not a new one. Seven states already have
parity laws covering mental health or substance abuse; four states are studying the parity
issue; and sixteen other states, including Connecticut, have in the past introduced parity
bills. Congress has also passed a mental health parity law.

Numerous studies have examined the anticipated ramifications of
parity on premium rates under various legislative proposals. For example, in Connecticut,
the Office of Health Care Access (OHCA) estimated that mental illness and substance
abuse benefits account for approximately $100 of the premium of $2,076 for a single
person, and $240 of the premium of $4,946 for a family, or about 5% of the total premium
in the benefits package for a small employer PPO plan. OHCA further estimated that the
cost of providing parity of benefits between medical/surgical and mental illness/substance
abuse increases this premium by $18 per year for an individual, and by $42 for a family.
Substance abuse benefits alone account for even less of the annual premium and, therefore,
the estimated cost of providing parity would be even less than the figures cited above.

Moreover, the net savings to society, while not precisely
quantified, are estimated to be significant in the long run; those societal savings
include restoration of health of the substance abusers; restoration and healing of
families; less child abuse; fewer highway deaths; reduction in illegal drug trafficking,
theft, prostitution and other crime; reduced use of coverage for "medical"
illnesses (i.e., prevention of medical complications and their costly treatment); less
employee absenteeism; and more employee productivity. Finally, paritys appeal is
enhanced by the continued spread of managed care, which provides a mechanism for
controlling costs, improving access, and assuring quality in health care delivery without
the need for strict limitations on care.

On the public side, the full continuum of substance abuse
treatment services is rarely available for Medicaid eligible individuals and families.
Failure to provide sufficient services to this population can only lead to increased
medical assistance and other costs for the public. The Presidents Commission on
Model State Drug Laws concluded that "[m]edical assistance that fails to cover a
sufficient level of alcohol and other drug treatment to provide a reasonable prospect of
recovery is medically and fiscally unsound and inconsistent with general medical
assistance practices of providing sufficient resources to secure recovery where
possible."

What is the full continuum of substance abuse services and
treatments that should be covered under the proposed parity bill? At a minimum, the
services should include screening, assessment, intervention, detoxification, short-term
and long-term inpatient rehabilitation, outpatient and intensive outpatient services,
family treatment, and methadone maintenance treatment. As to this latter reimbursable
item, methadone maintenance is the most thoroughly studied and documented effective
treatment for heroin dependence or dependence on other opiates. As is the case with
long-term insulin treatment for diabetics or renal dialysis for kidney failure, the
benefits of methadone maintenance treatment persist for as long as treatment is provided.
While public and private insurance typically covers the costs of insulin and dialysis for
as long as treatment is medically necessary, coverage for methadone maintenance treatment
is often denied or limited, decreasing access and availability. To improve the health of
people dependent on heroin and other opiates and to achieve parity with other medical
conditions and treatments, methadone maintenance treatment should be a required covered
service, and treatment costs should be covered for as long as they are medically
necessary. Again, the long-term savings via medical cost offsets alone would be
substantial.

To maximize the early and appropriate provision of substance
abuse prevention and treatment services, the legislature should review further and
consider as a strategy option placing such services on a par with medical/surgical
services in group health insurance policies and in the state Medicaid program. This
strategy option is consistent with The Governors Blue Ribbon Task Force on Substance
Abuses recommendation of minimum core benefits for substance abuse prevention and
treatment, and with the draft recommendations of the Health Care Committee of the
Connecticut Alcohol and Drug Policy Council.

In Appendix B, Bill No. 3, page B-5 is a draft of legislation to
implement this option.

Experts and non-experts agree that substance abuse is a major -- if not
the number one -- health problem in this country. Studies suggest that more deaths,
illnesses and disabilities occur as a result of substance abuse than any other preventable
health condition. Costs related to substance abuse are a major contributor to the
countrys total health care bill. Additionally, substance abuses total economic
cost to the U.S. economy -- including increased health care costs, poor health,
absenteeism and reduced productivity in the workplace, and drug related crime and violence
-- each year is astronomical. In 1994 Connecticut spent $2.96 billion on substance abuse
costs.

No population group is immune from substance abuse: it affects
men and women, and people of all educational levels, ages, racial and ethnic backgrounds.
Indeed, "[m]ost substance abusers (70%) in Connecticut are employed, well paid, and
well educated." The effects of substance abuse may be felt at birth (newborns exposed
to substances taken by their mothers during pregnancy), childhood (neglect and abuse
resulting from parents child abuse), and adulthood (family disintegration and
employment problems). Moreover, more than 50% of the new AIDS cases in Connecticut are
related to substance abuse.

Despite its myriad costs to society, Connecticut is not doing all
it reasonably can to address the substance abuse problem. Prevention is the key to
reducing these costs, and prevention first of all depends on the ability to identify
persons with such problems. Many of our front-line personnel -- primary care providers,
and health professionals in hospital trauma settings -- are hampered in their efforts to
deal with patients substance abuse problems, primarily for two reasons: lack of
training in substance abuse identification and care, and lack of reimbursement for their
time and effort. This scenario of lack of training and lack of reimbursement is
unacceptable for two reasons: first, the patient is entitled to more complete and timely
care, and, second, early identification and intervention is an opportunity to reduce
significantly the costs associated with substance abuse.

Medical evidence suggests that substance abuse screening,
intervention and treatment are effective for many people, although these activities must
occur periodically because substance abuse is an intermittent relapsing chronic disease.
These activities should be provided at the earliest opportunity. While it may take a
variety of forms, in essence

[s]creening is a process to differentiate people who have (or are at
risk of having) a specific medical condition from those who do not. The purpose of
screening is to identify conditions at an early stage, even before the onset of a
diagnosable disease. Thus, screening may be distinguished from diagnosis, which is usually
a more detailed, intensive process to determine what treatment to provide. Screening
assumes the earliest possible identification will benefit the health and general
well-being of the individual. It also increases the likelihood that low-cost interventions
may both reduce immediate harm and prevent in some patients the possible progression to
disease that would be more costly to treat at a later time.

In short, "screening is an essential first step in understanding a
patients medical needs and determining if there is an underlying substance use
disorder."

Screening, followed by appropriate intervention, is important in
attempting to curtail the devastating costs associated with substance abuse. Screening and
intervention are particularly, though not uniquely, critical in trauma settings. Indeed,

[t]here is extensive evidence and wide agreement in the field that
traumatic injury creates a "teachable moment" or a unique opportunity in the
course of the addiction process . . . . This teachable moment happens when a patient makes
a connection in his or her mind that the traumatic injury is a direct result of AOD
[alcohol or drug] use. Those who are able to make the connection may be more open to
accepting AOD education or treatment, greatly reducing their chances for reinjury and
improving their course of recovery from the injury.

Moreover, "[s]everal factors -- including the rapid advance of
managed care -- make this a propitious time in which to transfer SBI [screening and brief
intervention] to widespread applications. Changes in the organization and management of
health services are placing a premium on preventive care and lower cost
interventions."

As of October 1, 1992, each hospital in Connecticut was required
to establish and implement "a protocol whereby each patient who shows symptoms of
substance abuse shall be provided with informational referrals to (1) entitlement programs
for which the patient may be eligible; (2) area substance abuse treatment programs; and
(3) appropriate community-based support services." Screening and brief intervention
are implicit initial components of such a protocol. The Law Revision Commission conducted
an informational survey about each Connecticut hospitals experiences with the
statute and, based upon the results of that survey and suggestions from the Primary Health
Care Committee of the Connecticut Alcohol and Drug Policy Council, it is clear that
section 19a-509e should be expanded and improved, either by statute or by regulation.

It is also clear that "[w]e must overcome the barriers,
including lack of training and reimbursement, to the routine use of effective,
inexpensive, and brief [screening and] interventions for substance abuse disorders in
medical practice." The Law Revision Commission now suggests that the Department of
Public Health, in conjunction with health care providers and other appropriate interested
persons, study the development of substance abuse screening and intervention protocols for
use in hospital admissions and by primary care physicians; study ways to improve the use
and effectiveness of section 19a-509e; study ways to recognize and compensate health care
providers for their time and effort in substance abuse screening and intervention
procedures; and report its findings and recommendations to the General Assembly in 1998.
After all, "[w]e treat spinal meningitis to create good health, not to reduce medical
spending. Substance abuse should be treated for the same reason. It is a potentially fatal
health problem."

b. Training health care professionals in substance abuse issues.

As mentioned above, before treatment there must be diagnosis, and the
evidence strongly suggests that physicians regularly miss the diagnosis of substance
abuse. A number of reasons account for this state of affairs, chief among them is that
physician training has not required that they develop the knowledge, attitudes and
clinical skills needed to diagnose substance abuse and to intervene, treat or refer
patients as appropriate. Proper physician training is, therefore, essential to early
screening, intervention and treatment.

To enhance the early and proper diagnosis of substance abuse and,
thereby, the provision of early and appropriate intervention and treatment services, the
legislature should review further and consider further as a strategy option legislation
requiring initial substance abuse training before licensure for certain health care
providers. The Department of Public Health would develop standards for the initial
substance abuse training required before licensure.

Additionally, the legislature should review further and consider
as a strategy option directing the Department of Public Health to study issues related to
a continuing substance abuse education requirement for certain health professionals,
particularly for primary health care providers such as medical doctors and osteopathic
doctors in family practice, internal medicine, pediatrics, and obstetrics/gynecology;
physician assistants; and nurses. Currently, the state of Connecticut has little or no
initial education (apart from the requirements of a degree or certificate) or continuing
education requirements of any kind for these individuals.

According to a recent American Medical Association publication,
most state licensing boards require some level of physician continuing medical education.
Interestingly, Kentucky requires physicians and osteopaths, among others, to complete
educational courses on the transmission, control, treatment and prevention of HIV/AIDS,
another major public health concern often related to substance abuse. Just last session,
the General Assembly required each licensed acupuncturist to complete successfully a
course in clean needle technique prescribed by the Department of Public Health. Thus,
there is precedent for the Commissions suggestions.

These proposals are consistent with the draft recommendations of
the Health Care Committee of the Connecticut Alcohol and Drug Policy Council as well as
the recommendations of The Governors Blue Ribbon Task Force on Substance Abuse. A
draft of legislation to implement these options is in Appendix B, Bill No. 4, page B-5.

C. 4. Availability of treatment slots in
alternative to incarceration programs and halfway houses.
Top

It costs, on average, several thousand dollars more per year to
imprison a Connecticut inmate than it does to enroll an eligible convicted person in one
of the states residential substance abuse treatment programs, or to parole a
soon-to-be released inmate into a halfway house. Notwithstanding this fact, the state
sends to prison in any given year over 250 drug-dependent persons who, but for the lack of
space, could otherwise be safely and effectively supervised and treated in a residential
community-based setting. Likewise, an additional 250 inmates who have served all but about
eight months of their sentences, who have participated in treatment programs while
incarcerated, and who could safely be supervised in halfway house residential treatment
programs continue to be incarcerated for a lack of treatment slots.

The cost saving of providing adequate treatment slots is both
obvious and compelling. First, in the short term, the state pays more than is necessary to
house, feed, and supervise these individuals - more than twice as much as is necessary:
$18,000 vs. $8,700. Second, in the long term, substance abusing individuals who are
incarcerated are much more likely to reoffend than those who participate in alternative
programs that include substance abuse treatment. Approximately $4,650,000 would be saved
in incarceration costs per year.

The legislature should review further and consider as a strategy
option an increase in funding for two types of programs: 100 new treatment slots for
halfway house treatment programs for paroled inmates and released inmates supervised by
the Department of Correction and 100 new residential treatment slots for the alternative
to incarceration programs run by the Judicial Departments Office of Alternative
Sanctions and other agencies. Each residential treatment slot is used approximately 2.5
times each year; thus, 500 offenders who would otherwise be incarcerated would be placed
in supervised, more effective, and less costly residential community-based treatment.

The types of programs in which the additional slots would be
created are described in more detail below.

Halfway Houses (Transitional Supervision). The Department
of Correction currently operates 562 beds in the halfway house treatment programs.
Participants must have sentences of fewer than two years, have participated in drug
programs while in prison, and be determined by the correction department not to be a risk
to public safety. Generally, qualified inmates are transferred from prison to a halfway
house when they have completed all but eight months of their sentences. They spend about
four months in the halfway house (including residential drug treatment) and another four
months in a community supervised release setting.

Office of Alternative Sanctions. This office operates
several inpatient residential treatment programs for offenders who would otherwise be
incarcerated, but who are considered good risks for supervised community-based substance
treatment. Fresh Start is one state residential alternative to incarceration program
available for substance abusing female youthful offenders and their children. The program,
Fresh Start, includes slots for 22 female offenders and 11 of their children in Hartford.
In a structured environment, it provides clients with comprehensive services to address
the complex, interrelated problems (including substance abuse) that prevent them from
being successful citizens. Project Green is a four month residential service program
developed by the Office of Alternative Sanctions, the Office of Adult Probation, the
Department of Environmental Protection, and the Department of Mental Health and Addiction
Services. There are currently slots available for 24 participants in New Haven and 16
participants in Hartford. Program clients receive structured inpatient substance abuse
treatment and education during the evening hours and on weekends. At the same time, they
are required to perform community service for the DEP in state parks and forests four days
per week for a minimum of two months. After this two month introduction, they are required
to pursue employment and/or vocational opportunities while continuing to reside at the
program and participate in substance abuse treatment and education. Throughout the
program, clients receive individualized case management and life skills training. Clients
are referred to the program by either Adult Probation or the Department of Mental Health
and Addiction Services. Approximately 80 percent of the clients who begin the program
complete it.

An act to implement this strategy option is in Appendix B, Bill
No. 5, page B-15.

Connecticuts certificate of need (CON) process "requires
that health care providers obtain a government determination of public need before
undertaking major capital expenditures or adding or deleting beds or services."
CONs purpose "is to assure the appropriate allocation of state health care
resources."

The Governors Blue Ribbon Task Force on Substance Abuse
found that "[t]here is an immediate need to reduce the rigidity and complexity within
the regulatory and licensing rules that impact the provision of substance abuse treatment
services" in this state. As the Task Force explained, "[p]resently, substance
abuse facilities must apply for a Certificate of Need if they intend to introduce new
services, relocate existing services, or change the services they offer at an existing
location. This time-consuming process can take months to complete, resulting in added
costs to providers and inefficient utilization of treatment beds and outpatient slots. CON
application fees place a further burden on providers. There is some question as to whether
the Certificate of Need process for substance abuse facilities, as currently structured,
is serving a meaningful purpose." In the light of these considerations, the Task
Force recommended exemption of, or significant modification to, the CON requirements as
they relate to addiction service programs. The substance abuse treatment programs
currently exempt from the CON process by statute are simply too few.

To facilitate "timely access to all Connecticut citizens who
need prevention, intervention and treatment services" for substance abuse, the
legislature should review further and consider as a strategy option modifying the CON
program so as to exempt from its requirements the provision of substance abuse services or
treatment, and to raise from $1 million to $2 million the threshold limit for capital
expenditures related to the provision of substance abuse services or treatment. In this
way, substance abuse treatment providers will have greater flexibility in adapting to the
changing needs of the service population and, thereby, can maximize the provision of
services at the earliest possible opportunity.

This proposal is consistent with the recommendations of The
Governors Blue Ribbon Task Force on Substance Abuse. A draft of legislation to
implement this proposal is in Appendix B, Bill No. 6, page B-15. The proposed exemptions
have been placed in section 1 of the bill amending section 19a-154 by adding a new
subsection (g) (4) and in section 2 of the bill amending section 19a-155 by adding
language raising the threshold limit. In addition to the new exemptions related to
substance abuse services or treatment, the current exemptions from the CON program have
been moved from section 19a-5b into the CON statutes themselves as section 19a-154(g) (1),
(2) and (3) and section 19a-155(g) (1), (2) and (7). This will clarify the existence of
exemptions and gather all exemptions together in the CON statutes to make it easier for
the practitioner to locate them.

On August 22, 1996, President Clinton signed the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193) (the
"Act"). Section 115(a) of the Act denies federal cash welfare (now known as
Temporary Assistance for Needy Families) and food stamp eligibility to any individual
convicted under federal or state law of "any offense which is classified as a felony
by the law of the jurisdiction involved and which has as an element the possession, use,
or distribution of a controlled substance (as defined in section 102(6) of the Controlled
Substances Act (21 U.S.C. 802(6)))." However, the Act also expressly allows states to
reject that policy. The Act gives states three choices: (1) to do nothing, and thereby be
subject to the Act; (2) to exempt its domiciliaries from the disability - that is, allow
its domiciliaries to receive benefits; or (3) to limit the period of time for which the
disability will apply to the states domiciliaries. The latter two options, exempting
domiciliaries or limiting the disability, require state legislation to be exercised.
States that exercise either of these options are not financially, or otherwise, penalized
by federal law for rejecting the federal policy.

The ramifications to the convicted substance abuser of disability
under Section 115(a) of the Act are severe, and the disability may be for the convicted
persons lifetime. The Legal Action Center, a non-profit advocacy group involved in
human services issues, notes that " the provision will make it harder for
[residential substance abuse] treatment programs . . . to survive financially. These
programs, many of which cannot get Medicaid reimbursement, pool their clients public
benefits (including AFDC and Food Stamps) to support all the components of
treatment. For example, a substance abuse treatment program in Florida estimates
that 80% of its clients have felony convictions, and the loss of funds supporting clients
in treatment could leave significant gaps in the programs budget. "
The Legal Action Center also predicts that the provision will result in an increase in
crime as individuals lose support and access to substance abuse treatment and other
essential social services and, further, "will impede the efforts of drug courts and
other initiatives that divert addicted offenders from prison to treatment."

Joseph Califano, Jr., chairman of the National Center of
Addiction and Substance Abuse at Columbia University observed that a similar initiative to
deny federal Supplemental Security Insurance benefits to persons disabled by alcohol or
drugs would increase the crime rate and would be a false economy.

If we were intelligently using the reduction in benefits to get more
... [substance dependent persons] into treatment, it would make sense as public policy.
But to simply cut them off is insane. Its going to increase homelessness, increase
the incivility of our urban life and just savage [dependent individuals].

The Law Revision Commission believes that the federal policy of denial
of benefits to otherwise eligible substance abusers is shortsighted, undermines efforts to
address substance abuse through treatment and social programs, and jeopardizes the
states ability to "take every practical step within its sphere of authority and
responsibility" to devise a comprehensive and effective strategy to prevent substance
abuse and to treat substance abusers. Substance abuse wreaks havoc on families and on the
economy. The state policy should minimize those costs, where possible by successfully
treating substance abusers and returning them to society as economically viable,
productive citizens. Denying benefits that make treatment and a return to productivity
possible is, therefore, poor public policy, harmful to the individual, to his family, and
to society at large.

To further the State of Connecticuts goals as described
above, the legislature should review further and consider as a strategy option exempting
the state from the operation of the federal welfare disability, Section 115(a) of the Act,
as it is permitted to do without federal penalty or recrimination. That exemption is
necessary if Connecticut, as suggested by this report, is to create and implement a
comprehensive and cost-effective system for addressing substance abuse as a public health
issue.

Legislation to activate the exemption is set out in Appendix B,
Bill No. 7, page B-22.

Connecticuts education policy currently addresses the
problems of substance abuse. Section 10-16b of the General Statutes requires that drug
abuse prevention be taught as part of the required health and safety instruction in the
public schools. Section 10-19 further requires that the effect of alcohol and drugs, as
well as of nicotine, be taught each year to all students in all public schools grades.
Under section 10-220a, school boards must provide in-service training, approved by the
state board, to provide teachers, administrators, and guidance personnel with information
about the nature and relationship of drugs and alcohol to health and personality
development. School boards are also required to adopt policies and procedures for dealing
with student use, sale, or possession of drugs on school grounds. CGS section 10-221.
Under section 10-19a, the school superintendent may designate a substance abuse prevention
team, and section 10-19b allows advisory councils established under the federal Drug Free
Schools and Communities Act of 1986 to serve as a resource for public schools.

Pursuant to these authorities, the State Department of Education
has developed a curriculum guide specifically on substance abuse. That guide sets learning
objectives and activities geared to four major grade groupings: primary, upper elementary,
middle school or junior high, and high school. The guides objectives are intended to
give students the knowledge to act responsibly. The skills they develop are intended to
enable them to evaluate their behavior, take responsibility for their actions, and
understand the consequences.

The Department of Education also works with the Department of
Mental Health and Addiction Services (DMHAS) to develop a community-based partnership for
drug abuse prevention. In that effort, local agencies such as regional action councils,
local prevention councils, and other organizations are working toward creating a
prevention infrastructure on a community level.

Notwithstanding these activities, two areas of current policy
raise concerns. Current law does not ensure that substance abuse education receives the
appropriate level of priority in all communities, and it does not ensure that where a
school becomes aware of a substance abuse problem, an appropriate program is available to
address the students needs.

The level of attention granted to substance abuse education was
specifically delegated to local or regional boards of education by Public Act 95-182,
which provided that "the content and scheduling of [substance abuse] instruction
shall be within the discretion of the local or regional board of education." A
consequence of that local control is that the level of substance abuse education that is
provided in the communities is not systematically monitored.

According to the Office of Legislative Research, school districts
tend to offer about 25 hours of health education a year, on average, part of which is
devoted to drug abuse prevention. However, particular districts may, in fact, offer
substantially less attention. Moreover, because the content of the programs is locally
determined, it is not clear that all programs being offered meet the most effective
standards as they are currently understood. To the extent that programs are proven
effective, it may be that more resources should be directed their way.

Because prevention is a critically important component of drug
abuse policy - because it is so much more cost efficient and effective to prevent a
problem than it is treat it - drug abuse prevention in the schools should be given a high
priority on a statewide basis. Giving those programs priority will require that the state
monitor the programs currently in place and offer additional assistance and guidance to
those districts with programs that do not measure up. Moreover, outcome evaluations are
now ongoing on the effectiveness of the various prevention approaches. As information is
developed, the state should ensure that the most effective programs are put into practice.

The Law Revision Commission, therefore, recommends that the State
Department of Education conduct an ongoing survey of drug abuse prevention programs in the
communities, assess the effectiveness of those programs in the light of the expertise
available, and offer additional guidance to local and regional districts where deemed
necessary.

Moreover, as noted above, there is no systematic program in place
to ensure that each school district has access to appropriate guidance, counseling, and
treatment programs when a problem with student substance abuse is encountered. While many
districts do, in fact, have substance abuse counselors and programs directed to substance
abuse, it is apparent that others may not or do not. That variation in the quality of
service available can not be tolerated if the state is to ensure that substance abuse
problems are addressed as early and effectively as possible. Again, the state commitment
requires that the issue be monitored on a statewide basis.

The Commission, therefore, recommends that the State Department
of Education survey and monitor the availability of guidance, counseling, and treatment
programs for students in each of the local and regional districts. As part of that
process, local and regional boards should be required to report to the Department with a
comprehensive list of those services in use. Where services are unavailable, the need for
such services should be identified. Where inadequacies cannot be addressed within
available resources, the Department should report to the General Assembly on those needs.

Finally, as is recognized by the current community-based action
programs, preventing substance abuse requires a broad-based approach addressing not only
the substance abuse itself but also the conditions leading to it. Child-oriented programs,
community centers, sports programs, and other student activities all direct children
toward constructive activities. While those programs add to the opportunities and
experiences of children in many ways, they may also provide a cost effective approach to
substance abuse in the schools. Again, however, the availability of such programs is
determined on a local basis and remains essentially unmonitored statewide.

Because deficiencies in the availability of programs may be
exacerbating the substance abuse problem among teenagers, the availability of such
programs is a matter of state concern. A first step to addressing any deficiency will
require a systematic effort to assess program availability.

The Law Revision Commission recommends that the state Department
of Education undertake such an assessment in coordination with its current community-based
drug prevention initiatives. Pursuant to that assessment, the Department should report to
the legislature as to localities lacking in available community based programs for
children and adolescents.

At least 20 percent of injecting drug users (IDUs) in the
Hartford, New Haven, Bridgeport, Danbury and Waterbury areas are HIV-positive. Distressing
as that statistic sounds, it represents good news. In Hartford for example, only three
years ago, approximately 55 percent of this segment of the population was infected with
the virus that causes AIDS. This dramatic reduction in the rate of infection can be traced
to a change in state law that took effect in July 1992. Since that time, it has been legal
in Connecticut to buy, sell, or carry up to 10 hypodermic needles and syringes without a
prescription.

When IDUs share dirty needles, they engage in one of the highest
risk activities possible for the spread of AIDS. The Connecticut Department of Public
Health finds that by decriminalizing the limited sale and possession of syringes,
Connecticut has reduced needle sharing by 40 percent. This is a remarkable behavioral
change. By a simple statutory revision, and without spending a dime, the General Assembly
took a giant step towards improving Connecticuts public health. At the same time,
there is no evidence that needle decriminalization has increased the use of drugs. Rather,
it may have increased the number of IDUs who entered treatment programs, as a result of
referrals from needle exchange programs.

The Law Revision Commission believes that public health may well
be better served if the current 10-needle limit were increased to a number that more
nearly meets the demands of public health. Distribution of clean needles to IDUs has a
proven record of reducing the spread of AIDS in Connecticut. It appears likely that
increasing its reach will increase the public health benefit. Thus, the legislature should
review further and consider as a strategy option amending the statute authorizing
Connecticuts needle exchange programs, and amending the statute prohibiting the sale
or possession of more than 10 needles. To be consistent with these changes, CGS section
21a-267 (possession of drug paraphernalia), would also need to be amended.

The average IDU injects between 2 and 2.5 a day. Thus, if an IDU
were to obtain new, clean syringes once per week, he or she would need approximately 14 to
18 syringes a week. At the same time, experience in the New Haven needle exchange program
suggests that IDUs give approximately 25% of the clean syringes they obtain to other IDUs.
Factoring in this secondary distribution effect, an IDU might reasonably use 23 needles in
a week. Because needles come in packages of 10, an increase in the number of allowable
needles would need to be a multiple of 10.

This change is expected to facilitate the distribution of clean
needles to IDUs in two ways, and thus to reduce needle sharing.

1. Primary IDU distribution. The most obvious result of
increasing the 10 needle limit will be to increase the number of needles that IDUs can
purchase and carry. As a result, IDUs will be able to ensure that they have enough clean
needles when pharmacies and needle exchange programs are not available to them.

2. Secondary distribution. Perhaps more important, it has
been demonstrated that IDUs who obtain clean needles often distribute them to other IDUs.
Some IDUs either cannot or do not take advantage of the opportunity to purchase clean
needles from pharmacies or obtain them from needle exchange programs. This secondary
distribution of clean needles has the same health benefits in reducing the spread of
disease as does the primary distribution.

A "drug-dependent person" as defined in section
21a-240(19) is a person who "has developed a physical and psychic dependence" on
drugs. This criteria of "physical and psychic dependence" does not correspond to
any currently-accepted definitions of drug dependence within the health care profession.
The Department of Mental Health and Addiction Services has called the definition
"vague and not functional in determining drug dependency for the court."

The definition also directly conflicts with the definition of
"drug-dependent person" in section 19a-126 of the general statutes where, in
contrast to the ambiguous language in section 21a-240(19), "drug-dependent
person" is defined as a person "who has a psychoactive substance dependence on
drugs as that condition is defined in the most recent edition of the American
Psychiatric Association's Diagnostic and Statistical Manual of Mental
Disorders." Instead of the vague criteria of "physical and psychic
dependence," this definition requires that an assessment of a drug dependent person
conform to currently accepted DSM criteria. Similar language is also used in section
46b-120 which defines "drug-dependent child" as "any child who has a
psychoactive substance dependence on drugs as that condition is defined in the most recent
edition of the American Psychiatric Associations Diagnostic and Statistical
Manual of Mental Disorders."

The legislature should review further and consider as a strategy
option revising the definition of drug-dependent person in section 21a-240(19) to reflect
the clear diagnostic standards required in sections 19a-126(7) and 46b-120. In addition,
section 21a-240(18), which defines "drug dependence" in vague terms as "a
state of physical or psychic dependence," should similarly be revised to create
consistent language in the statutory definitions. Appendix B, Bill No. 9, page B-25
contains a draft of legislation to implement this strategy option revising section
21a-240(18) and (19).

Since 1981, Connecticut has recognized the medicinal value of marijuana
by permitting physicians to prescribe marijuana as a medication to treat certain patient
disorders: glaucoma and the side effects of chemotherapy. That policy is embodied in CGS
sections 21a-246 and 21a-253.

Connecticuts legislation was part of a nationwide policy
shift begun in 1978 in which thirty-six states enacted legislation, in the face of federal
prohibitions, to permit patients to use marijuana for medicinal purposes. These laws
remain in effect in twenty-four states. State legislation concerning medical access to
marijuana generally falls into five categories: 1) therapeutic research programs; 2)
prescriptive or pseudo-prescriptive authority; 3) scheduling marijuana under state
controlled substances acts in a manner that allows its medical use; 4) medical necessity
defense, and 5) removal of state criminal liability and penalties.

Two factors restrict the application of Connecticuts policy
permitting medicinal use of marijuana: i.e., the number of disorders for which
marijuana can be used is limited and pharmacies cannot carry marijuana to fill
prescriptions written by physicians. In addition, without a change in federal law,
patients using marijuana and physicians or pharmacies dispensing it still face possible
criminal charges for violation of federal law.

Given these and other limitations on the use of marijuana for
medical purposes, several states - California, Ohio, Washington, Arizona, and
Massachusetts - containing 22% of the nations population have in recent months made
efforts to address the availability of medicinal marijuana. Below is a summary of the
actions in those states:

Washington. The state of Washington passed legislation in March
1996 allocating $130,000 to two medicinal-marijuana projects. Under the first project, the
state can seek approval from the federal government to become a source of marijuana for
research purposes. The second project will research the effects health of medicinal
marijuana.

Massachusetts. Also in 1996, Massachusetts Governor William Weld
signed into law a bill directing the Massachusetts Department of Public Health to adopt
rules and regulations within 180 days to establish a marijuana medical research program.
The bill also anticipates a medical necessity legal defense in the future.

Arizona. In a statewide initiative in November 1996, Arizona
voters adopted a provision that permits a physician, when supported by a second medical
opinion, to prescribe marijuana (and other controlled drugs) for medicinal purposes to
seriously ill or terminally ill patients. A patient who uses or possesses a prescribed
controlled substance would not be subject to criminal penalties.

California. California voters adopted Proposition 215 in
November 1996 which allows a physician to authorize the medical use of marijuana for
certain disorders. A patient who has a physicians recommendation for medicinal use
of marijuana is not subject to a criminal conviction on a charge of possession marijuana,
although the patient is at criminal risk for sale or distribution.

Ohio. Similarly, a 1995 revision to the Ohio code gives a person
a defense to a charge of possession of marijuana if the possession is pursuant to a
physicians prior written recommendation for medicinal purposes.

If Connecticut legislators choose to make Connecticuts medical
marijuana statute more available to treat disorders, revisions based on the approaches in
other states should be considered. Using these approaches, Connecticut could permit the
medical use of marijuana for properly screened patients under a physicians care
while continuing to prohibit its use for nonmedical purposes. Below are key features of
such an approach:

A physician may make a written recommendation for use of marijuana for
specific disorders: glaucoma, side effects of chemotherapy, neurological disorders such as
multiple sclerosis, and acquired immune deficiency syndrome (AIDS).

To issue such a recommendation, a physician-patient relationship must
exist and the physician must determine that the patient is faced with clear and imminent
harm from the disorder, that marijuana would effectively abate the harm, and that no
alternative would be equally effective for the patient in abating the harm.

The written recommendation must meet the statutory standards of a
prescription and must be for no longer than six months.

The recommendation must identify the disorder for which the marijuana
is to be used.

A person using marijuana pursuant to such a physicians
recommendation would not be subject to criminal liability for possession.

Physicians making such recommendations must register with the
Commissioner of Consumer Protection.

Diversion for nonmedical purposes is not permitted.

A physician-designated caregiver for a disabled patient would have
statutory protections.

The list of disorders for which marijuana may be medically administered
is expanded to include AIDS and neurological disorders such as multiple sclerosis and
epilepsy. Anti-convulsive effects and spasticity reduction have been reported, and many
AIDS patients report that smoking marijuana reduces their nausea, increases their
appetite, reduces pain and generally improves their well-being. Although some states have
expanded medical use of the drug beyond these four disorders, case studies and anecdotal
information support limiting the medical use of marijuana to these additional conditions.

Specifically, amendments would:

a. Revise section 21a-253 (Possession of marijuana pursuant to
a prescription or written recommendation by a physician.) as follows:

Subsection (a) permits an individual to possess, cultivate, grow
or have under his or her control marijuana for his or her own medical use under a
physicians authority. Subsection (a) provides also that the marijuana may be grown
or kept by a caregiver designated by the physician, in accordance with subsection (d), for
the patients use only and may not be distributed by an individual to others (other
than by a physician in accordance with section 21a-246). This provision is not intended to
permit the operation of "buyers clubs" or "users clubs" as exist in
other states. Further, the person must show that he possesses or is growing the marijuana
either pursuant to a prescription from a licensed physician in accordance with section
21a-249 and section 21a-246, or pursuant to the written authorization of a physician,
issued in accordance with subsections (c) and (d) of this section. If the legislature
repeals section 21a-278 as elsewhere discussed in this report, the reference in subsection
(b) to section 21a-278 should be removed.

New subsection (b) provides that a person who possesses,
cultivates, grows or has under his control marijuana pursuant to either a prescription or
written doctors authorization is not subject to criminal liability for possession of
marijuana. To obtain the benefit of the defense, the prescription or authorization must
have been issued before an arrest.

New subsection (c) requires physicians wishing to authorize the
medical marijuana to register with the Commissioner of Consumer Protection. The
Commissioner must maintain a current list of physicians registered to authorize marijuana
for patients. The registry is intended to aid police and prosecutors in determining the
authenticity of a written authorization. The subsection relieves physicians from criminal
liability or from professional sanctions (such as having their licenses revoked or
suspended) for authorizing a patient to use marijuana or for supplying marijuana to a
patient where the physician can show that, in his professional judgment: (1) the patient
faces clear and imminent harm from the medical conditions specified; (2) marijuana would
be effective in abating that harm; and (3) no alternative is legally available that would
abate the harm equally as effectively for the patient. The latter provision is intended to
address the experience of many patients for whom legal alternatives (Marinol, for example)
are ineffective. Thus, the mere availability of legal alternatives does not end the
inquiry. The legal alternatives must actually abate the harm to the particular patient to
preclude his substituting marijuana, or to prohibit a physician from recommending
marijuana to that patient.

New subsection (d) requires an authorization to be signed by the
authorizing physician, to identify the disorder for which the physician is issuing the
authorization, and to be written in accordance with subsections (a) and (b) of section
21a-149 governing the form and content of prescriptions. The physician may designate a
caregiver for the patient in the authorization. The caregiver could, under subsection (a),
grow marijuana for the patient who may be too ill to do so himself. An authorization is
valid for six months after its date of issuance (which must be noted on the
authorization). After that period, the patient must obtain a new authorization to be
protected by the statute.

The revised provision continues to permit the Commissioner of
Consumer Protection to license physicians to possess and supply marijuana for the
treatment of glaucoma or the side effects of chemotherapy, and adds neurological disorders
and acquired immune deficiency syndrome (AIDS) as conditions for which marijuana may be
prescribed.

C. 11. Pilot research program for medical
maintenance of chronic out-of-treatment opiate-dependant persons.
Top

The health threat posed by injecting drug users in the age of HIV and
AIDS is, perhaps, the most daunting, disturbing aspect of societys drug problems.
Injection drug use accounts for the overwhelming number of new HIV infections in
Connecticut. Thus, injection drug use is the most important risk behavior leading to the
spread of AIDS in the state, impacting all races of needle-sharing heroin users. The
impact is especially severe among Hispanic and black Americans between the ages of 25 and
44. AIDS is the leading cause of death in those age groups, and over half of those deaths
are related to injection drug use

The practice by injection drug users of sharing of contaminated
needles also threatens spreading AIDS to children and other non-drug users. Injecting drug
users who have contracted AIDS spread the disease to spouses, sexual partners, their
children, and others with whom they trade sex for drugs. The spread of AIDS has continued
notwithstanding intensive state and federal efforts to suppress drug use through the
criminal justice system. The Commissions report on drug policy identifies a number
of initiatives to ensure that those who are at risk receive treatment, education,
training, and a legitimate opportunities to put self-destructive drug use behind them. In
strategy option C. 8, above, the Commission points out how Connecticuts needle
program, an important initiative to reducing the public health risk from the spread of
AIDS and other diseases, can be improved.

Those initiatives should help. Societys longstanding
experience with drug use suggests, however, that, notwithstanding these efforts, a core
group of chronic long-term heroin-dependent users exists, and will likely continue to
exist in the foreseeable future, that is impervious to existing treatment options or
criminal sanctions. Because of their drug dependence, limited life skills, and other
disabilities, these chronic heroin users are simply incapable, or unwilling, to manage
their lives to avoid high risk conduct. With their high risk practices, they are either
HIV positive or at high risk of contracting the disease. Repeat incarcerations and
treatments have failed to modify their behavior and little reason exists to believe that a
new round of traditional interventions will be beneficial. A significant aspect of our
current approach is to attempt to warehouse those persons in prisons at costs upwards to
$30,000 per year for long stretches. Moreover, a large portion of available treatment
resources are diverted to fruitless treatment of this relatively small number of
intractable users. At any given time, moreover, only a minority of these persons are
locked up or in treatment. During periods when the person is in the community, and,
perhaps, even during periods of incarceration, the chronic drug user is a primary vector
threatening himself and others with the prospect of contracting a fatal disease. In short,
current programs have proved both costly and ineffective in addressing the problem of some
chronic, untreatable hard-core users.

The Governors Blue Ribbon Task Force on Substance Abuse
notes the need for new initiatives with respect to these chronic drug users, commenting,
with respect to chronic users generally (including chronic alcoholics and poly drug
users):

"Steps can and should be taken to improve the lives of these very
sick persons and to lessen their inappropriate consumption of substance abuse treatment
resources. Alternative programming designed to meet this populations very special
needs should be tested by pilot programs in areas of the state that experience the highest
incidence of costs due to these types of cases. Appropriate programming for these
individuals would relieve the negative cost impact of their repeated use of expensive
services that are neither appropriate, nor effective for their needs."

The National Institute on Drug Abuse has also called for
"innovative strategies to reduce high-risk drug-using behaviors and to recruit,
engage, and retain [out-of-treatment, chronic] drug users in treatment." A special
committee of the American Bar Association has also called for increased treatment focused
on the chronic drug user and for innovative research into treatment, including
pharmacotherapies.

A new treatment approach for these chronic drug users is
desperately needed if the state of Connecticut hopes to control AIDS and effectively use
available resources. One such possible treatment approach is currently being used, with
reported success, in Switzerland. Notwithstanding its controversial nature, this program
deserves serious consideration as an approach to limiting the spread of AIDS and avoiding
the waste and ineffective use of available treatment resources.

Under the Swiss treatment program, which is subject to strict
medical and other controls, selected hard-core untreatable heroin users are maintained on
pharmaceutical heroin that is hygienically administered in a supervised clinical
environment. Such a program has the potential of reducing the incidence of high risk
injections on the street and the resultant spread of disease. The Swiss program has also
shown promise as an approach to improving the physical and mental health of the user,
improving that persons social integration, reducing his illegal activities, and
reducing or controlling the persons ongoing drug use.

Patients were admitted to the Swiss treatment program only after
a comprehensive assessment procedure that targeted hard-core drug users who had not
benefited from conventional drug treatment. The Swiss entry criteria were as follows:

At least two years of opiate dependence from consumption of heroin or
another opiate on a daily basis;

At least two failed attempts at treatment, including detoxification,
methadone maintenance, and residential treatment;

Based on initial success with 250 participants, the program expanded to
1000 participants: 800 received injectable heroin each day in prescribing programs in
fifteen different cities; 200 participants received morphine and injectable methadone. The
heroin is administered at clinics open every day. The amount of the dose was determined by
whatever the participant wanted. Most clinics allowed up to one gram of pharmaceutically
pure heroin a day, administered in up to three visits a day. Others allowed higher doses.
More intensive research on participants in one of the Zurich programs found that clients
opted to stabilize their daily dose and even to cut back. All injections were administered
in an injecting room where the staff prepared the syringes and the participants injected
themselves. A waiting room was provided for before and after the injection.

The government cost was approximately $50 per day. Participants
were required to pay approximately $7.50 or about 7% of the street price.

A participant could be banned from the program for driving, for
bringing drugs in or out of the facility, for failing to comply with research requirements
such as drug testing and group therapy, or for exhibiting violent behavior.

Foremost, the Swiss believed that the program would reduce the
spread of AIDS and reduce the criminal activity of participants. They also felt that the
regularized maintenance program would allow the addicts to reassert control over their
lives, allowing them to stabilize their consumption habits and avoid the underground
milieu of criminal drug sales and use. The program also sought to assist addicts by
helping them with living arrangements, employment, and relationships.

The Swiss concluded that the feasibility of heroin maintenance
programs was demonstrated by their trial which incurred no major negative incidents. The
retention rate in treatment was approximately 80% for fifteen months. The Swiss considered
four primary factors in evaluating the program: the feasibility and public acceptance of
the program; the attractiveness of the program to the targeted chronic substance abusers;
retention rates; and induced behavioral changes. As reported by Swiss researcher Ueli
Locher, there were no drug overdoses, there was no leakage or black market diversion of
heroin from the facilities, and there were no problems reported of disruption in the
neighborhoods. Locher reported that the maintenance program broke the ties of participants
to the illicit drug markets and that participants experienced general improvement in their
lives.

The 80% retention rate in treatment is significant because these
clients, who all had chronic dependence, had previously rejected or done poorly in
treatment. The 80% retention rate included those who stayed in the heroin maintenance
treatment program (67%) and those who left the program to receive methadone treatment or
other treatment services.

In a more intensive study of 366 participants, Locher found:

Participant use of heroin stabilized and tended toward declining use;

Participants experienced improved physical health;

Participants experienced improved social integration such as housing
and employment;

Participants experienced financial relief;

Cocaine and other illegal non-opiate drug use (except marijuana) also
declined.

The relevance of the Swiss program to Connecticut is obvious.
Connecticut needs effective programs that will control the proliferation of AIDS.
Connecticut needs treatment programs that will address criminal activity of the most
intractable chronic drug users. Connecticut needs cost-effective programs that reduce the
social harms spread by illicit drug use. The Swiss heroin-maintenance program promises to
address those needs by reducing the harms spread by the chronic heroin user. Although a
relatively costly treatment program (about $15,000 per year in Switzerland), the program
is far less costly than untreated drug dependence with its attendant health risks for the
spread of AIDS, criminal liabilities, and other serious social consequences.

Societys experience with opiates has well demonstrated
their dangers. Providing drugs in a culture attuned to zero-tolerance is apparently
incongruous. Yet, one does not have to condone substance abuse to recognize that, in the
day of criminal activities that support drug dependence, AIDS, infectious hepatitis, and
tuberculosis, it is of critical importance to bring the worst chronic substance abusers
into the health system. The state should take cognizance of scientific and fiscal
realities and health necessities.

Given our lack of successful alternatives to traditional
treatment and incarceration for chronic users, the apparent success of a controlled
medical program in Switzerland, and the fact that the Governors Blue Ribbon Task
Force and other reliable authorities have called for alternative pilot programs to address
the needs of this chronic population, such a program must receive serious attention for
those chronic abusers, especially those who are HIV positive. The legislature should give
such a research program further consideration. Appropriate waivers by federal authorities
must, of course, be obtained. Should the legislature choose to conduct a pilot study,
Appendix B, Bill No. 11, page B-28 contains an act that would establish such a pilot
program for medical heroin maintenance of chronic, untreatable heroin users.

Since July 1996, the Judicial Department has operated a Drug
Session in New Haven Superior Court three days each week. A Drug Session is planned for
Bridgeport in the near future. Under this program, drug-dependent defendants charged with
possession of controlled substances in New Havens G.A. 6 can apply to have their
cases transferred to a single docket dealing exclusively with drug cases. The focus of the
Drug Session is to coordinate the responses of the judicial, treatment, social service and
education systems to help defendants get off drugs and to reduce drug-related criminal
activity. An important component in the success of drug courts is direct judicial contact
with an accused on a regular ongoing basis during his or her time in the program.

Defendants have various incentives for applying. If accepted,
those without prior criminal records can have the charges against them dismissed if they
complete court-ordered drug treatment programs. If they are unsuccessful, these
defendants cases are returned to the regular criminal docket. Defendants with minor
criminal records can plead guilty, with the agreement that the court will vacate their
pleas and dismiss the charges against them if they complete the programs. Finally,
defendants with more extensive records can plead guilty with the understanding that they
will face a particular term of incarceration or other penalty if they do not complete the
court-ordered drug education and treatment programs.

Judges in other criminal courts have discretion to order these
types of remedies, but three things make the Drug Session unique:

First, the Drug Session deals exclusively with drug-dependent
defendants. It is designed to channel these defendants into appropriate treatment
programs, while providing ongoing incentives to keep them motivated and participating. The
New Haven Drug Session has one judge, Judge Jorge Simon. While their cases are pending,
defendants are required to appear before Judge Simon once every two to four weeks. The
program length is generally about 48 weeks.

Second, prosecutors and defense attorneys play a less adversarial role
in Drug Session than they do in traditional criminal courts. In the drug court, they
function first as members of a team dedicated to the goal of rehabilitating the defendant.
In New Haven, Assistant States Attorney Robyn Stewart Johnson and Assistant Public
Defender James M. Chase handle all cases. Each is involved in the decision of whether to
admit a particular defendant to the program.

Third, the judge directly oversees the defendants progress in the
programs. At any time, the judge can terminate the program and impose whatever sanction
was agreed upon for failure. As an alternative, the judge can impose intermediate
sanctions, such as confining the defendant to jail for a few days, but allowing the
defendant to continue under the Drug Sessions supervision. At every step in the
process the judge has a service coordinator available to provide referrals to appropriate
treatment programs and design effective judicial responses. While the decisions to grant
or deny a defendants application, and what remedies to fashion are the judges
alone, the service coordinator in New Haven Superior Courts Drug Session sits next
to the judge on the bench.

While their cases are pending in the Drug Session, participants agree
to several conditions: (a) a year of daily treatment with random urinalysis; (b) bi-weekly
court appearances in front of the same judge; (c) release of treatment information for
court monitoring purposes; and (d) keeping all treatment and other required appointments.
A defendants progress is assessed by a team made up of the judge, court personnel,
prosecution and defense attorneys, probation staff, and others.

Drug court is intended to reduce reliance on incarceration as a
response to the drug problem, provide treatment to nonviolent drug using defendants,
provide early and continuing judicial supervision for nonviolent drug abusing defendants,
and reduce recividism. As of May 1996, drug courts have been implemented in 29 other
states. While it costs an average of $25,500 to incarcerate a state prisoner each year,
the Judicial Departments Office of Alternative Sanctions estimates it costs only
$3,000 to supervise and treat a defendant in the Drug Session.

Not only are drug courts less costly than prisons as a way for
dealing with drug-involved offenders, but evidence shows that drug courts are more
effective at preventing recividism in defendants than ordinary criminal courts which
impose traditional sanctions for drug crimes, such as incarceration. Because
Connecticuts program is new, no recividism statistics are yet available. However,
other jurisdictions report that while 45 percent of drug defendants reoffend overall,
recividism rates are between 5 and 28 percent for defendants who participate in drug
courts. In Dade County, Florida, where the Drug Court handled 4,500 cases between 1989 and
1993, 89 percent of defendants did not reoffend.

Other economic benefits have been realized as well. Prosecutors
and police report that drug court programs reduce their police overtime and witness costs,
because they do not need to testify in cases handled by drug court. Most programs also
report that while a substantial percentage of defendants receive public assistance and
welfare when they enter the program, many obtain employment while in the program.

As Connecticut redirects its efforts toward a treatment approach
for dealing with nonviolent drug-involved offenders, it is important that effective tools
such as the drug court be implemented widely and as quickly as possible. Even though the
Drug Session was initiated as a pilot program, the success of the program elsewhere and
the promised of success of the pilot here in Connecticut suggests that the legislature
should consider, even before conclusion of the pilot, authorizing the Judicial Department
to open Drug Sessions as soon as possible in all parts of the state.

To assure that the various Drug Sessions operate under the same
policies and procedures, the Judicial Department could implement statewide standards for
the courts. The public act creating the Drug Session provides that the court should be
available to all offenders "who could benefit from placement in a substance abuse
treatment program." To assure that judges have discretion to admit to the Drug
Session a broad range of appropriate drug-dependent offenders, the Judicial Department
should consider expanding the eligibility criteria to permit all drug-involved offenders,
except those charged with murder, kidnaping, robbery in the first degree, or any felony
involving serious physical injury, to be considered for admission to the Drug Session.

a. Distinction between sales by drug-dependent persons
and by non drug-dependent persons and mandatory minimum sentences

Under section 21a-278 of Connecticut law, mandatory minimum
prison sentences are established for persons (1) who sell narcotics, hallucinogens,
amphetamines, or one kilogram or more of marijuana and (2) who are not drug dependent at
the time of the offense. Lesser penalties for those who sell drugs and are drug dependent
are established in section 21a-277.

Connecticut is one of only three states in the nation to make a
statutory distinction between drug-dependent persons and non drug-dependent persons for
the purpose of establishing enhanced penalties for those in the latter group who sell
drugs. In 1995, inmates incarcerated for offenses under section 21a-278 as non
drug-dependent drug sellers represented 11% of all inmates incarcerated in Connecticut for
drug offenses. The Commission has examined the history and application of section 21a-278
and concludes that the statute not only impedes the policy objective of bringing
Connecticuts drug abusers into the health care system, but also significantly
undermines our criminal justice system.

Before the enactment of section 21a-278 in 1971, the general
statutes had one penalty section applicable to all drug sales without regard to whether a
defendant was drug-dependent. Decisions regarding the severity of each individual
defendants sentence were made by our courts within the parameters set by law. Before
1971, Connecticut law stipulated that a person, regardless of drug dependency, who was
convicted of selling any quantity of narcotic drugs could be sentenced to a term of
between five and ten years in prison for a first offense. A sentence could, however, be
suspended in whole or in part at the discretion of the court. By enacting section 21a-278,
the legislature sought to remove the courts sentencing discretion for defendants who
were found to be non drug-dependent at the time of the offense.

Initially, both the legislature and the Connecticut Supreme Court
viewed section 21a-278 as an "additional crime" for the state to use in
penalizing drug sales offenses by non drug-dependent persons. To convict a person, the
legislature intended and early court decisions required that the prosecution prove beyond
a reasonable doubt not only that a defendant sold drugs, but also that the defendant was a
non drug-dependent person at the time of the sale. In hearing its first case under section
21a-278, the Connecticut Supreme Court rejected a defendants claim that his
conviction should be reversed on the ground that "the evidence was insufficient to
justify the finding, beyond a reasonable doubt, that he was not a drug-dependent person at
the time of arrest." The Court, in affirming the conviction, held that on "the
evidence presented, the jury could have concluded that the state had proved beyond a
reasonable doubt that the defendant was not a drug-dependent person at the time of his
arrest" (emphasis added). Thus, the Court explicitly interpreted that the
language of the statute made the condition of being a "non drug-dependent
person" an element of the offense, which the state bore the burden of proving beyond
a reasonable doubt.

However, nine years later in State v. Januszewski, the
Court withdrew from its initial position and held that the condition of non drug
dependence is not an element of the offense under section 21a-278. The prosecution
thereafter had no obligation to prove that a defendant was a non drug-dependent person at
the time of the offense in order to obtain a conviction under section 21a-278 for illegal
sale by a non drug-dependent person. Instead, under the Court's ruling in Januszewski,
all defendants are presumed to be non drug-dependent persons at the time of a drug
sales offense. Defendants who want to contest the issue of non drug dependence bear the
burden at trial of proving by a preponderance of the evidence that they were
drug-dependent at the time of the offense.

The Courts rationale for its holding in Januszewski
was that drug dependence fits an "exception" to the offense. It reasoned that
burdens of proof for exceptions to drug-related offenses are guided by section 21a-269
which stipulates that it is not the states burden "to negative any
exception" contained in any Title 21a provisions, but rather "the burden of
proof of any such exception...shall be upon the defendant." Thus, as an exception,
drug dependence must be raised at trial and proven by the defendant. The Court further
noted that a "defendants drug dependency at the specific point of time in the
past at which the offense occurred is certainly a matter personal to the defendant and
peculiarly within his own knowledge," and "logic" should not place the
"burden of proof on matters personal to the defendant" upon the State.

While the Courts reasoning may have represented one logical
interpretation of the language of the statute, it did not correspond to the purposes
expressed by the members of the legislature in passing the law in 1971. During House
hearings, the sponsor of this law, former Representative Bernard Avcollie, responded to
several areas of concern among his colleagues when he stated:

The intent of the bill is to give the states attorney and the
prosecuting attorney an opportunity to charge an additional crime which does carry a
harder sentence which goes towards imprisoning the person who is not drug dependent and
who is, in fact, selling drugs for a profit.

The "additional crime" about which Representative Avcollie
spoke was the crime of being a non drug dependent-drug dealer as distinguished from the
perceived less serious crime of being a drug dependent drug dealer. Several members of the
House expressed concern that the new laws harsh non-suspendable mandatory minimum
prison sentence for the sale of any quantity of drugs might be applied not only to the
organized drug pusher, but also to a young person who gave a small quantity of a drug to a
friend. Representative Avcollie acknowledged that while prosecutors would have discretion
to charge in each case, the law indeed could be applied equally whether the sale of drugs
was committed by a young person in an isolated incident of bad judgment or by an
enterprising individual in conjunction with large, organized crime operation. Avcollie
further explained to his colleagues that before charging under the proposed law, the
prosecutor would be required to establish that a defendant was not a drug-dependent person
at the time of the offense:

[I]n order to charge under this law, a states attorney or a
prosecuting attorney would have to take advantage of the existing law...and have the party
arrested and examined for drug dependency. In other words, you would first have to
prove that he was or was not addicted and then charge him with this crime. (emphasis
added)

Representative Avcollie reemphasized at several points during the
hearing the procedural requirements incumbent upon the prosecution - an individual could
only be charged under the proposed law "at the time of the arrest if a states
attorney or prosecutor had him examined for drug dependency." Since pre-trial drug
treatment diversion programs would obviously not be appropriate for non-drug dependent
defendants, this preliminary determination was essential prior to charging so as to divert
eligible defendants into treatment programs as needed. Thus, it seems apparent that the
legislature, in passing section 21a-278, did not have in mind the kind of application of
the law we have seen since the Januszewski decision where individuals charged under
section 21a-278 bear the burden of proving the issue of drug dependence at their own
trial.

Nevertheless, in writing the law, legislators failed to consider
how procedurally difficult it would be to weed out the drug dependent from the non
drug-dependent prior to charging. As the states attorney argued in his Januszewski
brief to the Connecticut Supreme Court:

It is frequently very difficult, if not impossible for the State to
prove non-drug dependency in most cases. The State has no right to compel a defendant, at
the time of his arrest, to submit to the taking of a blood sample, or a urine test or a
psychiatric examination. Such may be procured under our practice only after an order of
the court based on a finding of probable cause by the court. Even if an order is entered,
the defendant can take an appeal from such an order and by the time the Supreme Court has
acted, the value of the test might well be destroyed.

As currently applied, section 21a-278 presumes all defendants to be non
drug dependent and requires that a defendant provide evidence of drug use at trial. This
application of section 21a-278 has been problematic in two ways. The definition criteria
that a defendant must meet in order to carry the burden of proving drug dependence are
ambiguous. A defendant must show at trial that she is a "drug-dependent person"
as defined in section 21a-240(19) which states that a drug dependent person is one who
"has developed a physical and psychic dependence" on drugs. This criteria of
"physical and psychic dependence" does not correspond to any currently accepted
definitions of drug dependence within the health care profession. The Department of Mental
Health and Addiction Services has called the definition "vague and not functional in
determining drug dependency for the court." In strategy option C.9. earlier in this
report, the Law Revision Commission pointed out how the definition of drug dependence
could be revised to reflect contemporary medical standards and to be consistent with other
statutory provisions.

In addition to the definition problem, two significant
constitutional issues arise from the requirement that defendants must prove drug
dependence at their own trial on a charge of illegal drug sale by a non-drug dependent
person. First, a sixth amendment issue emerges when considering the influence that such
evidence may have on a jurys impartiality and, second, a fifth amendment concern
arises in relation to a defendants right against self-incrimination. In effect,
defendants who provide evidence at trial of extensive involvement with drugs in an attempt
to prove that they meet the exception of drug dependence risk thwarting their own defense
against the charge of selling drugs. Instead of meeting the burden of proving drug
dependence, such defendants may only succeed in convincing a jury that they have a drug
problem. For example, a defendant may only be able to show that she was a drug user or
abuser at the time of the offense, neither of which would meet the statutory definition of
drug dependence. In such a situation, a defendants self-incriminating admission of
drug use or abuse can inadvertently assist the prosecution in its burden of proving the
charge of selling drugs. After hearing a defendant testify to drug use, jurors may be
understandably unable to exercise their impartial judgment in deciding the issue of
whether the defendant sold drugs. Thus, defendants who undertake the burden of proving
drug dependency risk fostering in the minds of jurors the suggestion that "where
theres smoke, theres fire." This risk has been far from inconsequential -
the penalty for a non drug-dependent person convicted of selling or giving away any
quantity of a drug under section 21a-278 is a mandatory minimum five years in prison which
may not be suspended or reduced by the court.

Not only does the current application of section 21a-278 dilute both an
individuals fifth amendment right against self-incrimination and the sixth amendment
right to an impartial jury, the law also tends to distort the legal process in other
subtle ways. First, the mandatory minimum sentencing provisions disable judges from
exercising discretion in cases where an individuals drug problem, while not reaching
the level of statutorily-defined dependence, has clearly influenced her involvement in
selling drugs. (Ironically, persons with drug abuse problems not at the level of clinical
dependence who turn to other crimes such as larceny or burglary to support their drug use
face far less serious penalties than similar users who become involved in selling drugs.)
Second, while disabling judges from determining appropriate individualized sentences, the
law simultaneously empowers prosecutors to wield the mandatory minimum sentencing
provisions as leverage in plea negotiations with defendants, most of whom are unwilling to
gamble on an attempt to establish drug dependence.

According to the Office of the Chief Public Defender, under the
current statutory scheme a majority of defendants - even those with obvious drug problems
- opt to plea bargain with the prosecution rather than risk prejudicing a jury against
them in an attempt to prove drug dependence. Resourceful prosecutors are aware of this.
Knowing that most defendants prefer to plea down to a lesser charge to avoid a trial in
these cases, prosecutors have a strong incentive to charge everyone arrested for the sale
of drugs as a non drug-dependent person under section 21a-278 (regardless of whether the
accused shows signs of drug dependence) in order to negotiate a favorable plea. Yet, even
when prosecutors choose not to make charging decisions on this basis, practically
speaking, because they have no reliable way of determining whether or not an individual
was drug dependent at the time of the offense, they have little alternative but to charge
all persons arrested for selling drugs under 21a-278 as non drug-dependent persons.
Prosecutors are not experts in determining clinical drug dependency issues, nor are the
police for that matter. Thus, as the law stands now, most drug sellers, whether drug
dependent or not, are initially charged as non drug-dependant persons.

To resolve the procedural inequities and functional problems
inherent in section 21a-278, the legislature should consider revising the law to eliminate
the distinction between drug-dependent persons and non drug-dependent persons, as well as
the mandatory minimum sentencing requirements. This strategy option would be achieved by
repealing section 21a-278. All illegal sales would be charged under 21a-277. Penalties for
sales under section 21a-277 are quite strict: up to 30 years depending on the number of
offenses and the type of drug involved.

Mandatory minimum sentencing laws have been the subject of
intense controversy in recent years. A 1994 policy paper reprinted in Corrections
Compendium: The National Journal for Corrections Professionals reported that mandatory
minimum sentencing for drug offenses have not succeeded in deterring drug sales because
most dealers "do not consider that they will be caught and do not consider the
consequences." The study also concluded that the most dangerous drug dealers,
so-called "drug kingpins," avoid mandatory minimum sentences by hiring destitute
and desperate "mules" as delivery people or street sellers. These minor players
in drug distribution operations are the persons most often subject to mandatory minimum
sentences for first offenses. Thus, society expends enormous resources arresting,
prosecuting, and incarcerating small-time offenders while the major players continue to
circumvent the law.

A 1996 study by the Rand Corporations Drug Policy Research
Center showed that mandatory minimum sentencing strategies have been less cost-effective
than traditional enforcement when applied to low level people in drug distribution
organizations. The study concluded that "conventional enforcement [where courts have
discretion to impose appropriate individualized sentences] is more than twice as cost
effective as mandatory minimums in reducing cocaine use."

The recently-issued report by the Connecticut Legislative Program
Review and Investigations Committees on Connecticuts substance abuse policies
for juveniles and youth recommends that mandatory minimum sentences for drug offenses be
repealed in Connecticut. The report states that there is "consensus among criminal
justice professionals that treatment programs [are] as or more effective than traditional
incarceration" and recommends that "Connecticuts public policy address
substance abuse as a health problem that should be dealt with through prevention,
education, and treatment efforts in addition to criminal sanctions."

To ensure that criminal sanctions do not needlessly subvert
Connecticuts prevention, education, and treatment efforts to minimize the costs of
substance abuse, the legislature should review further and consider as a strategy option
eliminating mandatory minimum sentences. Sentencing decisions would be returned to the
courts where judges may make determinations on an appropriate sentence after an evaluation
of a defendant's personal and criminal history.

Such a change would address the constitutional problems that have
emerged in the application of section 21a-278 since it was approved by the legislature in
1971. At that time, those who voted for the bill did so with the understanding that the
law targeted the non drug-dependent "pusher" and that a determination of a
persons dependence on drugs would be made before trial. Subsequent interpretation
and application of the law have not fulfilled the legislatures goals and a
perversion of the law has resulted. Judges will have discretion under the section
21a-277(a), as amended, to administer extremely strict sentences of up to 30 years
imprisonment to non-dependent persons who sell drugs, while offering treatment to those
who need it.

For similar reasons, the legislature should review further and
consider revising section 21a-278a concerning distribution by a non dependent-person to a
youth or near a school to correspond to the changes recommended in sections 21a-277 and
21a-278. Section 21a-278a imposes an extra two to three year mandatory minimum sentences
on (a) non drug-dependent individuals who sell drugs to minors under eighteen years of
age, (b) on individuals who sell drugs near schools or public housing projects, and (c) on
individuals who use minors to sell drugs. As revised, even though the mandatory nature of
the sentence would be eliminated, a judge could still impose the extra two to three year
sentence in appropriate cases.

The same rationale for eliminating the procedural and functional
problems associated with both mandatory minimum sentencing and non-drug dependent status
of section 21a-278 is applicable to section 21a-278a. The legislature should review
further and consider returning to the courts the authority to make individualized
sentencing determinations for all offenses involving the sale of drugs. The courts will
have discretion to impose an additional two years in prison on individuals convicted under
section 21a-277 when the offense involves the sale of drugs to a minor or near a housing
project or school, or when it involves the use of a minor to sell drugs. A
defendants dependence or non-dependence on drugs will not be an issue to be
determined at trial, but may be a factor that the court considers in sentencing decisions.
By returning sentencing discretion to the courts, drug treatment options are not
absolutely and arbitrarily foreclosed as they are under a mandatory minimum sentencing
scheme. Yet, such revisions would continue to authorize courts to administer, when they
deem appropriate, severe enhanced penalties on offenders who sell to minors or near
schools or who use minors as drug couriers.

The Commission recognizes that while an emphasis on treatment
over punishment for many of Connecticuts troubled citizens who become involved in
drug crimes will further the public health and safety of our state, a treatment approach
may not be universally appropriate. Some defendants may not want to make a commitment to
treatment. Others may have no need of treatment because they do not have a substance abuse
problem. For such defendants, criminal sanctions are appropriate. A court would have
discretion to sentence such defendants to prison terms of up to fifteen years for a first
offense and up to thirty years for subsequent offenses.

b. Distinction between cocaine and free-base cocaine.

Another consequence of repealing section 21a-278 is the
elimination of enhanced penalties for the sale of cocaine in free-base form. In 1987, the
legislature passed a revision to section 21a-278(a) that distinguished powder cocaine from
cocaine in free-base form for the purposes of imposing enhanced penalties for sales of the
latter. Powder cocaine is produced by dissolving coca paste in hydrochloric acid and
water, adding potassium salt to separate undesired substances from the mixture and then
adding ammonia to separate a solid substance - the powder cocaine - from the solution. It
is the most commonly used form of cocaine. Cocaine base is produced from powder cocaine
into one of two forms: free-base cocaine, derived from powder cocaine that has been
dissolved in water and an alkaloid solution like ammonia; or crack cocaine, derived from
powder cocaine that has been dissolved in a solution of water and sodium bicarbonate,
boiled into a solid substance, dried, and broken up into "rocks."

Powder cocaine can be injected, snorted, or ingested; cocaine
base is smoked. According to data The National Institute on Drug Abuse (NIDA) between 1988
and 1992, 71% of those who used cocaine at least once during year 1992, snorted cocaine,
while 27.9 percent smoked cocaine.

Under current Connecticut law, an individual who sells one half
of a gram of free-base cocaine is subject to a mandatory minimum five years and up to life
in prison while an individual would have to sell over fifty-six times that amount of
powder cocaine (one ounce) before being subject to the same penalties.

Connecticut is one of only 9 states in the country to have a penalty
distinction between free-base and powder cocaine. The legislature in 1987 supported the
legal distinction between powder cocaine and free-base cocaine "because of the highly
addictive nature of [free-base] and its easy accessibility." Several months earlier
the United States Congress, in response to public concern and media coverage of cocaine
use as a factor in the June 1986 death of college basketball star Len Bias, had initiated
a federal criminal law distinction between "cocaine base" and other forms of
cocaine. Congress created a 100-to-1 quantity ratio in differentiating crack cocaine from
powder cocaine in the penalty structure. The justification for this distinction was based
on the perception that crack cocaine caused greater physical, emotional, and psychological
damage and was linked to violent crime and gang activity.

Penalty distinctions between base and powder cocaine have been
criticized on several fronts as unfair, unjust and racist. Demographic data showing the
racial composition of crack and powder cocaine offenders in Connecticut is not currently
available. Statistics at the federal level, however, show that crack cocaine offenders are
88.3 percent black. In contrast, the racial distribution of powder cocaine offenders is
more evenly composed of 32 percent white, 27.4 percent black, and 39.3 percent hispanic.

Penalizing the sale of crack more harshly than the sale of powder
cocaine because of its association with gang violence has been criticized as being
inadequately supported by logic. At a U.S. Sentencing Commission hearing held on the issue
in 1993, several critics argued that violence is more attributable to underlying gang
culture than to the type of drug being sold. As one scholar put it: "Crack is simply
processed [powder] cocaine...so that distinction [between crack and powder] just is not a
sensible distinction." Numerous law enforcement officials throughout the country
agree. A sergeant in the Narcotics and Special Investigations Unit of the Washington, DC
Metropolitan Police in explaining his views on why penalty distinctions between base and
powder cocaine should be eliminated stated: "it takes fifteen minutes to turn powder
cocaine into crack cocaine - a box of baking soda, a pot of water, and a microwave or a
stove, and you have crack cocaine."

Critics have also assailed the grounds that the distinction is
justified because of the "highly addictive nature" of base cocaine. Dr. Charles
R. Schuster, Senior Research Scientist at the Addiction Research Center of the National
Institute on Drug Abuse testified at the U.S. Sentencing Commission hearing that
"cocaine is cocaine is cocaine, whether you take it intranasally, intravenously, or
smoked."

The Journal of the American Medical Association recently
reported that free-base cocaine is no more addictive than powdered cocaine. The study
showed that "cocaine, regardless of whether it is crack cocaine or [powder] cocaine
hydrochloride, leads to the same physiological and behavioral effects." Dr. Schuster
and the JAMA authors recognize that the onset of physiological and psychotropic effects
vary depending on the route of administering cocaine into the body. Snorting and ingesting
produce less rapid effects than injecting or smoking cocaine. Injecting powder cocaine and
smoking crack cocaine produce equally rapid effects on the user. Dr. Schuster and the JAMA
authors suggest that because individuals may prefer the ease of use associated with
smoking a drug rather than the difficulties associated with injecting one intravenously,
smokable crack cocaine may pose greater public health consequences. However, it does not
follow that because individuals might more readily smoke than inject a drug that the sale
of smokable drugs ought to be penalized more harshly than the sale of injectable ones.

A final critic of penalty distinctions between powder and crack
cocaine at the U.S. Sentencing Commission hearing was Dr. Ira J. Chasnoff, President of
the National Association for Perinatal Addiction and Professor of Pediatrics at the
University of Illinois. Commenting on the effects of prenatal exposure to cocaine, Dr.
Chasnoff stated that "the pharmacology of cocaine and crack is identical. They are
identical drugs, so any effect you have on the fetus is similar, whether the woman uses
crack or uses cocaine." Admitting that while he could not speak directly to the issue
of heavier penalties, he urged that if the goal of public policy is to benefit children,
"then we are going to have to find other ways than taking their mothers away and
putting them in jail."

Noting that those involved in the distribution of crack cocaine are
younger than those distributing powder cocaine, the JAMA authors assert that the enhanced
penalties for crack have driven drug dealers to recruit juveniles as drug sellers because
of the potentially less severe sentencing for juveniles when arrested. While the authors
agreed with the findings of the 1995 US Sentencing Commission that free-base cocaine
"is easier to use and more accessible to a broader population" than is powder
cocaine, it maintained that quantifying a sentencing differential ratio is impossible at
this time because of the limited research in the areas of "social context, current
availability, and associated deleterious consequences."

The legislature should review further and consider whether to
eliminate the penalty distinction between free-base and powder cocaine. Forty-one other
states in the nation make no such distinction. By eliminating the distinction, Connecticut
will authorize courts to target for drug treatment and education those individuals who
will most benefit from such an approach, while reserving harsher criminal penalties of up
to 15 years imprisonment for a first offense and 30 years for subsequent offenses for
predatory individuals who sell cocaine in any form, regardless of how it has been
chemically constituted. As the authors of the JAMA study emphasized:

Prison is a scarce commodity in the United States, and if treatment has
the potential to decrease the likelihood that the individual treated will return to
selling cocaine, it makes sense to try that approach first. In fact, drug abuse treatment
has been shown to work about as well when mandated by the courts or under conditions in
which users have the option to go into treatment or go to jail as when it is voluntary. By
imprisonment of these individuals, society is choosing the most expensive option to deal
with a problem that, for some, can be managed more effectively by intensive outpatient
therapy combined with meaningful supervision for the criminal justice system.

The five-year-old alternative to incarceration programs are among
Connecticuts most effective antidrug tools. While some of the programs were designed
originally to ease prison overcrowding, they have proven to be unusually successful in
dissuading drug-related defendants from committing further crimes. In the case of drug
offenders under age twenty-one, for example, those who enter the alternative programs are
only 30 percent as likely to reoffend as those drug offenders sent to prison. Participants
in other age groups are less likely to reoffend as well. At the same time, the programs
are much less expensive than incarceration.

One flaw, however, exists in the way the statutes creating these
programs are established. Most restrict participation to defendants who have not
participated before, and who have no criminal record. The legislature should review
further and consider as a strategy option removal of these "one-time-only"
restrictions for drug-involved defendants whose crimes do not involve violence. Judges
need discretion to order drug-related defendants into the alternative programs regardless
of the defendants prior history.

The most important reason for this change is that it generally
takes more than one try before a drug-dependent person is able to control his or her
addiction. Experts on drug treatment warn that drug dependence is a chronic, relapsing
condition. Treatment clients will likely require multiple interventions, and many will
fail at least once before they succeed. While drug dependence is a medical disorder,
current treatment methods do not offer a permanent and complete cure for many persons.
Rather, often the best medicine can do is to help the drug-dependent patient control his
or her symptoms, "just as complete symptom elimination is not possible with the
treatments for diabetes, hypertension, asthma, or many other disorders."

Medical evidence suggests that many drug-related offenders placed
in the alternative to incarceration programs will require more than one intervention and
treatment to control their drug dependence. We know, therefore, that many of the clients
referred to the alternative to incarceration programs will fail to achieve long-term
success on the first try. However, with each additional intervention, the likelihood of
success increases for many. It is extremely difficult for drug-dependent persons to
control dependent behavior on their own in the long-term. Those who suffer from many other
medical problems, such as hypertension and diabetes, are unable to control their problems
without continuing medical support.

Numerous studies show as well that drug treatment can be more
effective and less costly than incarceration in controlling many drug-involved criminal
justice offenders. Even if it does not "cure" a drug dependent persons
dependency, treatment at least reduces illegal drug use and attendant criminal
behavior. It prevents rearrest more effectively and less expensively than incarceration.
As a bonus, persons in treatment have improved health and social functioning.

These concerns are even more important in the cases of younger
defendants. In a recent report, the Connecticut Legislative Program Review and
Investigations Committee recommended that the one-time-only restrictions be removed.
Substance abuse is a "chronic and progressive behavior and is a direct or indirect
factor in juvenile crime," but the law does "not take into consideration the
reality of drug use by children." Many first-time offenders participating in the
programs are only 16 or 17 years old. Under current law, these young offenders get only
one chance at a very early age to participate in the alternative programs.

It is illogical and counterproductive to the interests of public
safety, public finance, public health, and the health and needs of a drug-dependent person
to deprive him or her of treatment interventions simply because the "trigger"
is, by statute, a criminal offense. Judges need discretion to consider the information
they have received about the defendant, the recommendation of the states attorney,
and the interests of public safety before making the most appropriate placement of a
defendant, whether it be incarceration or other sanctions.

To accomplish these objectives, the legislature should review further
and consider as a strategy option the proposed legislation outlined below. The proposals
would affect three programs.

Accelerated Rehabilitation. Defendants who have criminal
records, or who have been through AR in the past are currently ineligible for the program.
The strategy option would give courts discretion to invoke AR notwithstanding a
defendants prior history where the primary or most serious charge pending is
possession of narcotics or drug paraphernalia, or where the defendant is drug-dependent,
and the charged conduct is likely a result of his drug dependence. The latter provision is
intended to apply to drug-dependent defendants charged with crimes like criminal mischief,
larceny and prostitution. The statute would expressly provide that no defendant could be
admitted to the program if his charged conduct caused the death or serious injury of any
person other than the defendant himself. Additionally, the court would have to find that
the defendant would benefit from drug treatment or education.

Court Liaison Program. Under current law, the court may waive
the "one time only" rule for defendants who apply to the program before trial,
but may not waive the rule for defendants who apply after conviction. The proposed change
would give the court discretion to waive the post-conviction restriction for defendants
whose primary or most serious conviction is for possession of narcotics or drug
paraphernalia, or for drug-dependent defendants charged with non-violent crimes where the
charged crimes are likely to have been the result of the defendants drug dependence.

Youthful Offender Program. This program is currently unavailable
to defendants who have previously been convicted of a crime, or who have previously been
adjudged a youthful offender. The recommended changes would entitle the court to try a
defendant as a youthful offender or accept his guilty plea to the charge of being a
youthful offender notwithstanding these restrictions if the primary charge pending against
him is possession of narcotics or drug paraphernalia, or if his charged offense (other
than a class A felony or first-degree sexual assault; the same restrictions currently
included) likely was the result of his drug dependence.

The Community Service Labor Program (CSLP), created by statute in
1990, is administered by the Office of Alternative Sanctions. It allows first-time
defendants charged with drug possession to apply to do community service in lieu of
prosecution.

The number of CSLP clients each year has grown steadily. In
fiscal year 1991/92, 1,156 clients participated; by 1995/96, that number had increased to
7,925. Despite the high number of participants, however, no statistics are kept on what
percentage of the participants avoid further offenses. Participants in alternative to
incarceration programs generally are less likely to reoffend than defendants who are
convicted and sentenced to prison. However, the Law Revision Commission believes that CSLP
is less effective and efficient than it might otherwise be because it fails to address the
involvement with drugs that underlies the offenses of defendants in the program.

The Law Revision Commission believes that several changes to the
CSLPs authorizing statute would increase the effectiveness of the program. Those
changes would (1) require CSLP participants to complete an appropriate program of drug
education or treatment, under the supervision of the Department of Mental Health and
Addiction Services and (2) expand the class of drug defendants who are eligible for the
program. These changes are similar to those advocated in a recent report by the
Connecticut Legislative Program Review and Investigation Committee. The changes are
discussed in detail below.

Drug education and treatment. In 1996, the Governors
Blue Ribbon Task Force on Substance Abuse recommended the creation of a pretrial drug
education program for first-time drug possession offenders, similar to the pretrial
alcohol education program now offered to first-time DUI offenders. Legislation based on
that recommendation was introduced in the Senate last year, but died in the appropriations
committee. The Department of Mental Health and Addiction Services also has recommended
similar legislation.

While the Law Revision Commission agrees with the need for a drug
education program, the Commission believes that incorporating such a drug education
program into the CSLP would increase the effectiveness of both programs. By combining
those programs, the state takes a "carrot and stick" approach to illegal drug
use. The combined program will provide defendants with structured support to address their
drug problems, while providing a level of sanction to express state disapproval of their
involvement with drugs. In line with the Commissions general view of how to deal
with substance abuse issues, substance abuse will be treated as a medical condition
requiring intervention, but individuals will be held responsible for taking conscious
steps towards resolution of their problems.

Lack of a drug education component is a major shortcoming in the
CSLP. CSLP does not require that clients receive any screening, testing or counseling to
determine the extent of their substance abuse. Alternative programs such as CSLP are much
less expensive than incarceration, and alternative sanctions programs that include drug
treatment components are effective at reducing recividism. Thus, CSLP should be more
effective if required to incorporate drug education and treatment. "Intervening with
offenders at the earliest possible opportunity can reduce jail and prison populations,
streamline court dockets, and prevent first-time, non-violent offenders from becoming
enmeshed in a criminal cycle." Even if treatment does not "cure" a
drug-dependent persons problem, or cannot prevent all casual users from returning to
that lifestyle, treatment and education do, in fact, reduce illegal drug use and attendant
criminal behavior during the time of treatment and education, and for a considerable
period thereafter.

Expanding the class of eligible defendants. The CSLP
currently restricts participation to first- and second-time defendants charged with drug
possession (section 21a-279) or drug paraphernalia possession (section 21a-267). If the
defendant has been convicted of any drug offense, or has participated in the CSLP before,
he may apply once for the CSLP after a guilty plea in lieu of prison time.

The Law Revision Commission believes that the legislature should
review further and consider as a policy option removing these one-time-only restrictions.
Without drug education or treatment, recividism is likely to be fairly high. Treatment --
and repeated treatment -- provides the tools, often more effectively than incarceration,
to reduce repeated involvement with the criminal justice system. No drug education and
treatment program can "cure" drug use or addiction 100 percent of the time. Some
defendants will reoffend even with the addition of the education component. While drug
dependence is a medical disorder, current methods often require repeat treatment
interventions. "[J]ust as complete symptom elimination is not possible with the
treatments for diabetes, hypertension, asthma, or many other disorders," drug
treatment may not, in all cases, eliminate the disorder; treatment is, however, successful
in helping the drug-dependent patient control his or her symptoms Experts on drug
treatment warn that drug dependence is a chronic, relapsing condition. Treatment clients
will often require multiple interventions, and many will fail at least once before they
succeed. Experience shows, however, that treatment -- even repeated treatment -- is a more
effective and less costly way to reduce drug use and its attendant crime than is
incarceration of a drug offender.

The legislature should also review further and consider as a
strategy option expanding program eligibility to include defendants who are charged with
sale of drugs, or with possession of drugs with intent to sell, if they can establish
that they are drug dependent. If a defendant is selling drugs to support his own
addiction, both he and the citizens of the state of Connecticut may be better served if he
gets the intervention and treatment he needs. The evidence suggests that defendants who
are incarcerated have an increased likelihood of repeated criminal behavior compared with
those supervised and treated outside the prison setting. Because drug sales offenses are
more serious than drug possession offenses, defendants who qualify for the program after
being charged with drug sales would face much longer periods of community service.

It is important to note that these changes would merely expand
the ability of the court system to use the CSLP in an appropriate case. A defendant is not
guaranteed admission to the program. The decision rests with the judge to decide, based on
the circumstances of the case, whether society and the defendant will be better served by
incarceration or by CSLP and drug education or treatment. The statute requires that the
court consider the recommendation of the prosecuting attorney in making that decision. In
short, the changes would make the potential benefits of the CSLP option available in a
significantly larger number of cases.

Anecdotal evidence accumulated in the past several years suggests
that police departments that adopt community policing philosophies are more successful in
stemming the flow of illegal drugs and the accompanying crime. By developing relationships
with community members and attacking root causes of crime, by using civil remedies, by
upgrading community services and facilities, and through social service referrals, police
can take a proactive approach, intervening at the community level before criminal activity
develops that requires an arrest. Many police departments in Connecticut already use forms
of "community policing". For example, police departments have established
satellite or substation offices, lessened the reliance on vehicle patrols, assigned
officers to walking patrols in neighborhoods, and made use of the Safe Streets-Safe
Neighborhoods grant program.

The U.S. Department of Justice has identified the core components
of community policing as community partnership and problem solving. The concept of
community partnership between law enforcement and the community requires police officers
to develop relationships with residents. Police officers seek to function within the
community as participants, and not from above as enforcers. Through the partnership with
community members, problems can be identified before they become serious. When a problem
is identified, the partnership can undertake solutions that may range from neighborhood
activities and community social work to increased police visibility.

Community policing has broader goals than more traditional
enforcement-oriented policing, which by nature tends to focus on making arrests and
winning convictions. An enforcement-oriented approach, for example, might emphasize
documenting arrests and convictions as evidence of successful policing. Critics of this
approach now include a growing number of police chiefs who note, for example, that the
drug war arrests and convictions target low level street dealers and users, and let
higher-ranking drug dealers get away. Critics suggest that a police department that
focuses primarily on arrests and convictions tends to lose sight of the positive effects
that community policing has in preventing crime, particularly drug use, through
neighborhood social action and visibility. Of course, necessary enforcement and effective
response to crimes that do take place are also important in a community policing regime.
Community policing, however, recognizes that police have a much broader role and that
their responsibilities, including their enforcement responsibilities, are more effectively
met if they work in concert with their community.

A special committee of the American Bar Association endorsed
community policing and argued that "every patrol officer, not just specialists,
should be engaged in community policing. A city should be divided into as many sub-beats,
or satellite offices, as there are generalist patrol officers." Other studies of the
effectiveness of community policing in combating the drug problem have similarly found it
to be the most effective approach. It provides police with the one of the most effective
tools available to law enforcement: the eyes and ears of the people who live in the
neighborhoods they patrol. "Observations, criminal intelligence information and
influence, especially among young people, are indispensable to police in ensuring public
safety."

The legislature should review further and consider as a strategy
option developing additional programs to assure that community police techniques are used
appropriately by all local police departments. Those programs might include the
establishment of a grant program to local police agencies as an additional incentive to
implement community policing. Similarly, the legislature should review the adequacy of
police officer education and training requirements. The effective implementation of
community policing requires ongoing training and education of police officers. Training is
necessary to teach officers the practical skills needed to police their communities.
Education is necessary to provide skills in critical thinking, problem solving, social
work, and communication. Police departments must have adequately trained personnel to meet
community policing objectives. A non-exclusive list of these skills might include
developing proficiency in Spanish where officers patrol a Hispanic community,
communicating with young people or people from different ethnic backgrounds, and
organizing and motivating community members.

Some existing grants and training programs already include
community policing. For example, the drug enforcement grant program, administered by the
Office of Policy and Management, provides funds to local police departments, state police,
and Division of Criminal Justice to enforce federal and state drug laws, undertake drug
use and crime prevention, education, or training activities and covers the costs of a
community-based police program. In addition, a safe neighborhoods grant program provides
funds to improve public safety in urban communities, involve residents in crime prevention
activities, and increase police presence. Thirteen of the states largest cities
(Bridgeport, Danbury, Hartford, Meriden, Middletown, New Britain, New Haven, New London,
Norwalk, Norwich, Stamford, Waterbury, and Windham) and the Police Officer Standards and
Training Council are eligible on a competitive basis for those grants. And the curriculum
of the Police Officer Standards and Training Council recognizes community policing.

Current funding, however, is not primarily targeted to
establishing community policing and the importance of meeting community policing
objectives is not universally recognized. If community policing is to be widely
implemented, the state needs to develop additional programs to attract participation in
all communities.

The legislature should review further and consider as a
strategy option revision of Connecticuts drug possession statute to make the
possession of a narcotic substance criminal only if it is a "weighable"
quantity. Arrests for possession of drug residue undermine the states interest in
limiting the spread of AIDS by injecting drug users and place police officers and other
members of the public at undue risk of accidental needle sticks from contaminated needles.

Current law prohibits the possession of any quantity of narcotic
substance, even of a quantity that is too small to be weighed. As such, the law may
undermine public health concerns by unnecessarily leading to the increased spread of AIDS
among injecting drug users (IDUs), their sexual partners and children, and the general
public. Police officers and other professionals who intervene with drug users are also
exposed to the increased risk from contaminated needles. Moreover, the current residue law
is, in fact, rarely prosecuted because of evidentiary difficulties and because the
existence of drug residue is often consistent with an innocent explanation.

Eliminating arrests for the possession of drug residue may have
the following results:

AIDS prevention. The General Assembly has recognized that
one important way to reduce the spread of AIDS among Connecticut citizens is to discourage
injecting drug users from sharing needles contaminated by the HIV virus. In 1992, the
legislature decriminalized the sale, purchase or possession of up to ten clean needles to
allow injecting drug users to obtain, possess, and use their own needles and to remove
their incentive to risk use of a contaminated needle.

However, the evidence suggests that this significant and
successful step towards reducing the spread of AIDS through shared needles is undermined
by the fact that an intravenous drug user may be arrested if he possesses a needle
contaminated with drug residue. Any needle, once used, will be so contaminated. Because
the possession of the drug residue on a needle is illegal, IDUs are discouraged by the
drug residue law from continuing to carry their own needles after use.

Yet, an IDU who has discarded his own needle after use because
possession is a felony offense may, thereafter, share a contaminated needle used by
another drug user for his next injection. Each incident of use of a shared contaminated
needle risks the spread of AIDS among Connecticut residents. If IDUs could legally carry
needles, regardless of whether they were used, needle sharing and HIV transmission would
be reduced.

Between March and November 1994, two University of Connecticut
researchers surveyed IDUs to learn whether the 1992 needle legislation had led them to
carry clean needles. Only 30 percent reported that they carried their own syringes.
Sixty-five percent of the drug users who did not carry their own needles said they did not
do so because they feared arrest. Moreover, despite their awareness that sharing dirty
needles can spread the virus that causes AIDS, many addicts use dirty needles if no clean
ones are available. "When you are dope sick, you dont care," explained one
35-year-old addict. At the same time, the percentage of IDUs who are HIV-positive is
astounding. At least 20 percent of the IDUs in Hartford, New Haven and Bridgeport are
infected with the virus that causes AIDS.

In short, it appears that the current fear of prosecution for
drug residue is a factor in the sharing of contaminated needles among injecting drug
users, and the resultant spread of AIDS. That reason, alone, may provide ample ground for
revising the law.

Police and public safety. A person who is stuck with a needle
contaminated with the HIV virus runs about a one percent chance of being infected, and
"stories are now commonplace of officers being pricked or stabbed by a drug
users dirty needle." Local statistics verify that being stuck is a significant
danger in police work. Officers have been stabbed intentionally with dirty needles while
making arrests, and have been accidently stuck while patting down a suspect carrying a
hidden dirty needle.

Yet, because the possession of the drug residue on a needle is
illegal, IDUs often hide their dirty needles on their person when faced with arrest.
Police searching such a suspect subsequent to arrest, or conducting a "Terry
frisk" or pat-down to ensure that the suspect is not carrying a weapon, risk
potentially fatal infection by such a hidden contaminated needle. The federal Centers for
Disease Control and Prevention recently addressed this problem by recommending the use of
the anti-AIDS drug AZT by police officers who are stuck with needles and who do not know
whether they have contracted the HIV virus. If IDUs could legally carry syringes,
regardless of whether they were dirty, IDUs would be less likely to hide the contaminated
needles and would be more likely to show his "works" to an officer on request,
lessening the likelihood of need a needle stick when a search is made. If not faced with
the possibility of arrest for possessing a contaminated needle, any rational IDU will
immediately disclose his needle to avoid risking an accidental infection.

The danger of needle sticks has other practical problems for law
enforcement. As noted above, the federal Centers for Disease Control and Prevention
recommends the use of the anti-AIDS drug AZT for use against accidental exposure to the
virus on the job. While AZT can reduce the chance of contracting AIDS from a needle-stick
or other accidental exposure by up to 80 percent, it carries with it severe side effects,
including nausea and vomiting. An officer who is stuck with a dirty needle does not know
for several months whether he has avoided infection. In the meantime, he suffers from
severe stress and anxiety. In one highly publicized case, a Springfield, Massachusetts
police officer who was stabbed by a hypodermic needle did not contract AIDS but was unable
to work for three years, and eventually retired from police work as a result of stress.
While "most [other types of] occupational exposures to HIV do not result in infection
transmission," factors present in the injection of an HIV-contaminated intravenous
needle into the system of a healthy individual make infection considerably more likely.

Police officers are not the only members of the public whose
risks are increased by the drug residue law. Because of their fear of arrest, IDUs are
more likely to store their used needles by hiding them in public places, or to discard
them on the street immediately after using them. In each case, nondrug users are exposed
to the risk of being inadvertently stuck with a contaminated needle. Researchers
conducting one study of Connecticut injecting drug users reported that they "observed
IDUs hiding syringes in public places (e.g. bushes) where they could potentially be found
and used by other IDUs. We also observed a child finding such a syringe." If IDUs
could legally carry syringes, regardless of whether they were dirty, the risk of
uncontrolled disposal of dirty needles would be reduced.

Additionally, practical problems and fiscal costs are associated
with prosecution of residue drug laws. Although police make arrests on the basis of drug
residue, the state health department lab reports that it "virtually never" tests
syringes for drug residue, and that they are aware of no state case in which a drug
possession conviction was obtained based on hypodermic needle drug residue. It is
apparent, therefore, that although fear of prosecution for residual drugs is very real in
the drug using community, the law itself does not provide an effective basis for
prosecution. In that light, police resources used for enforcement of the provisions would
have to be considered largely wasted even if the law was not, itself, counterproductive.

Again, criminalizing possession of drug residue has had a
negative effect on public health leading to needle-sharing, the transmission of disease,
and unnecessary risk to enforcement officers. The General Assembly may wish to consider
whether revising the drug possession statute to include only weighable amounts of
narcotics, in line with the other Commission strategy options to shift toward a public
health sensitive drug policy, will reduce those problems.

Unwitting Law-Breaking by Unsuspecting Citizens. Besides
the risks associated with enforcing the law against IDUs, statistics suggest that many
unsuspecting citizens unwittingly violate Connecticuts drug possession law. A recent
article published in the Journal of Analytical Toxicology reported that 79 percent
of the dollar bills in the United States contain traces of cocaine. Researchers analyzed
U.S. paper money in 14 cities and found that the amount of cocaine residue on the bills
varied from nanograms to milligrams. The degree to which clean money is contaminated
simply by being placed in the same drawer with "dirty" money is sufficient to
make drug-sniffing dogs identify it as contaminated money. Under current Connecticut law,
a person carrying contaminated currency is in violation of 21a-279 for possession of
cocaine, and could be subject to up to seven years in prison if convicted.

Legislation intended to remove the felony penalty for possession
of an unweighable quantity of narcotics was introduced in the 1996 session, but died in
the Judiciary Committee. In the light of increased awareness of the health problems used
or "dirty" needles pose not just to IDUs, but to police officers and ordinary
private citizens, the Law Revision Commission believes that public health demands full
consideration of a new version of this bill. The 1996 bill made possession of an
unweighable quantity of narcotics other than marijuana a class A misdemeanor. Continuation
of any such criminal penalty threatens IDUs with arrest for needle possession, a policy
that increases, rather than reduces, the risks stemming from intravenous drug abuse.

Presently in Connecticut, under section 21a-279(c) of the
general statutes, a first-time offender possessing a small amount of marijuana (less than
four ounces) may be imprisoned for up to one year and fined up to $1,000. Subsequent
offenses are felonies, permitting imprisonment for up to five years and fines up to
$3,000. (First-time offenders may be eligible for the community service labor program,
subject to statutory criteria in section 53a-39.)

The Law Revision Commission has examined laws from other states
that have reduced penalties for possession of small amounts of marijuana and the impact of
those laws in those states. Based on that review, the legislature should review further
and consider as a strategy option establishing the offense of infraction for adults
twenty-one years of age or older who possess one ounce or less of marijuana. It is
important to point out that the state will continue to exact a penalty from adults who
possess one ounce or less, and that penalty, if not paid, could result in a years
imprisonment.

Ten states have reduced the penalty for possession of small
amounts of marijuana. Five of them (Oregon, Maine, Ohio, New York and Nebraska) now treat
possession of small amounts of marijuana to be noncriminal violations. Two states
(California and North Carolina) retain misdemeanor status for possession of lesser
quantities of marijuana, but reduce the possible penalties from prior statutes. Three
states (Colorado, Minnesota, and Mississippi) have reduced the status of this kind of
violation from a misdemeanor to either a "petty offense" (Colorado), a
"petty misdemeanor" (Minnesota) or an "offense" (Mississippi). In
these states, for a first offense, a fine of not more than two hundred dollars may be
imposed (not more than one hundred in Colorado) but, in Colorado, a first-time offender
also might serve fifteen days in the county jail.

Maine and Minnesota define the amount of marijuana covered by
their statutes as a "usable amount" or a "small amount" respectively.
Most other states specify quantities, most commonly 25 grams or one ounce which is 28.35
grams. One ounce is approximately the weight of a small individual size container of
breakfast cereal. According to a report by The Lindesmith Center, "[a] typical joint
[cigarette] contains between 0.5g and 1.0g of cannabis plant matter." Thus, one ounce
of marijuana would yield approximately 28 to 56 marijuana cigarettes.

Studies of states that have reduced penalties for possession of
small amounts of marijuana have found that (1) expenses for arrests and prosecution of
marijuana possession offenses were significantly reduced, (2) any increase in the use of
marijuana in those states was less than increased use in those states that did not
decrease their penalties and "the largest proportionate increase occurred in those
states with the most severe penalties", and (3) reducing the penalties for marijuana
has virtually no effect on either the choice or frequency of use of alcohol or illegal
"harder" drugs such as cocaine.

Legislators are, of course, concerned whether reducing the
penalty for possessing a small amount will exacerbate any adverse health effects of
marijuana use. Marijuana use does have an effect on the body both physically and
psychologically. The extent of any adverse health impact continues to be a matter of
debate and depends, in part, on whether the use is light, moderate, or chronic. Because
increased use of marijuana in states that reduced penalties for possession did not appear
to be in excess of increased use in other states, and was, in fact, less than that of
states with stricter penalties, any increased adverse health effects should not be
expected to occur and may, in fact, be moderated by the reduction in penalties.

In Connecticut, according to figures provided by the Court
Operations Division of the Judicial Department, 8,981 offenses charging a violation of CGS
section 21a-279(c) were disposed of during the period of July 1, 1994 to June 30, 1995. Of
that number, only 1,700 were convictions and 7,281 resulted in not guilty dispositions or
were nolled. A "snapshot" of the Department of Correction population in 1995
shows that 57 persons were incarcerated for violation of section 21a-277(c), a 176%
increase in incarceration for this offense since 1991.

Proponents of lesser penalties for possession of small amounts of
marijuana point out that, of all the illegal drugs, marijuana is the least dangerous and
that millions of Americans know this and use it even in the face of criminal sanctions.
Proponents argue that it is misdirected public policy and expenditure of resources to
prosecute and incarcerate persons for possessing small amounts of marijuana when more
dangerous and violent criminal behavior requires the attention of criminal justice and
corrections. Misdemeanor and felony convictions of persons with small amounts of marijuana
also bring a lifetime of employment disability, a burden to all of society when such
persons can obtain only marginal employment.

All agree that criminal behavior while under the influence of
marijuana, such as driving while intoxicated, should be punished. The question for
legislators, however, is whether, in the light of our knowledge and experience with
marijuana, it continues to be appropriate to imprison adults who possess one ounce or less
of marijuana and whether, in the light of evidence that such a new sanction for possession
of small amounts of marijuana does not increase marijuana use, an additional sanction is
more appropriate and cost effective. In addition, over 80% of the marijuana possession
cases are either not pursued by prosecutors or result in verdicts of not guilty. The new
sanction would give prosecutors an additional option is dealing with these 80% of the
marijuana possession cases. The legislature should review further and consider as a policy
option whether to create a penalty of infraction for adults twenty one and over who
possess one ounce or less of marijuana.

Appendix B, Bill No. 17, page B-39 contains a bill that would
implement an infraction for this offense.